For which person would intensive insulin therapy be inappropriate?
a. a patient with a limited life expectancy
b. a patient who is newly diagnosed with diabetes
c. a patient with co-occurring kidney disease
d. a patient who needs short-acting insulin
e. a patient with type 1 diabetes
The correct answer and explanation is:
The correct answer is a. a patient with a limited life expectancy.
Intensive insulin therapy (IIT) is designed to maintain blood glucose levels as close to normal as possible, using multiple doses of insulin or an insulin pump. While this approach is effective in managing diabetes, it may not be suitable for every patient, especially those with specific conditions or circumstances.
For a patient with a limited life expectancy, intensive insulin therapy may not be appropriate due to the following reasons:
- Quality of Life Concerns: IIT requires frequent blood glucose monitoring, multiple insulin injections, and careful meal planning. For patients with a limited life expectancy, these demands may detract from their quality of life, offering little benefit in the remaining time.
- Increased Risk of Hypoglycemia: Tight blood sugar control can increase the risk of hypoglycemia (low blood sugar), which can be especially dangerous for older patients or those with other co-existing conditions. In a patient with a limited life expectancy, the risks associated with hypoglycemia may outweigh the benefits of achieving near-normal blood sugar levels.
- Less Aggressive Management: The goal of diabetes treatment in patients with a limited life expectancy is often to focus on comfort and symptom control rather than aggressive blood glucose management. Intensive insulin therapy could involve unnecessary complications that do not improve overall health outcomes.
For other patients:
- b. a patient newly diagnosed with diabetes: Intensive insulin therapy can help achieve tight glucose control and prevent long-term complications.
- c. a patient with co-occurring kidney disease: Despite potential complications, intensive insulin therapy can still be considered if monitored carefully, especially in type 1 diabetes.
- d. a patient who needs short-acting insulin: Short-acting insulin may be used as part of an intensive insulin regimen, depending on the patient’s needs.
- e. a patient with type 1 diabetes: Intensive insulin therapy is often the standard treatment for type 1 diabetes to mimic normal pancreatic insulin secretion.
Thus, for patients with a limited life expectancy, a more conservative approach is typically recommended.