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Long-term resistance to hypoglycemia would allow for more aggressive insulin regimens for patients, providing improved patient outcomes while reducing the incidence of adverse effects.
Several studies have shown that patient outcomes would be further improved by even more aggressive insulin dosing, but hypoglycemic episodes represent a limiting adverse effect [2], [3], [4], [5].
Such constructs may have multiple applications such as allowing for more aggressive insulin treatment regimens, treating hypoglycemia due to insulin-secreting tumors, providing synergistic efficacy in combination therapies with long-acting GLP1 analogs, and as an appetite suppressant for treatment of obesity.
One possibility is a selection bias that precluded the enrollment of minorities with more aggressive insulin regimens and better glycemic control.
It is conceivable that more aggressive insulin titration, giving higher insulin doses, would allow even more patients to reach A1C target, but perhaps at the expense of more hypoglycemia.
The implementation of progressively more aggressive insulin therapy protocols at our institution resulted in a large change in practice: the use of IIT rose from 9.6% of patients in period I to 42% in period III.
Similar(53)
The inclusion of glucagon can potentially allow for more aggressive up-front insulin delivery, as the glucagon can counteract the effects of overdelivery of insulin and prevent postprandial hypoglycemia (3, 24).
Therefore, the increase in severe hypoglycemia might be related to this more aggressive treatment, including higher insulin use and less sulfonylurea use with a lower HbA1c in patients with macroalbuminuria as a potential confounding factor of this study.
Our findings from a large prospective population study suggest that a more aggressive approach to reduce insulin resistance in high-risk individuals may substantially lower the risk of chronic kidney disease.
The HHNK state, in contrast, requires much more aggressive but vigilant hydration, and insulin should be avoided until the serum glucose ceases to fall with rehydration alone (14).
It has been suggested that this need for less basal insulin when using insulin glargine, along with the lower FBG levels it results in, may allow for more aggressive bolus therapy with fast-acting insulins, and this may further help improve glycemic control in patients with type 1 diabetes (Hershon et al. 2004).
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