The most common side-effect of insulin treatment is weight gain, which is thought to arise due to three possible causes. Firstly, insulin is known to have an anabolic (body-building) effect. In the second place, when good glycaemic control starts to be achieved due to insulin therapy, less glucose is lost in urine. This glucose is potentially available for storage as fat and it is possible that this accounts for some weight gain. Thirdly, insulin treatment makes people feel better and they usually find that it rapidly banishes unpleasant symptoms. A renewed sense of health and wellbeing may simply mean that the person recovers his or her appetite and feels able to eat more than before. In a minority of people, especially in those with Type 1 syndrome who have lost weight prior to diagnosis, regaining weight is a desirable outcome. However, for those who are already overweight, especially those with Type 2 diabetes, further weight gain is obviously unwelcome. Usually, if it happens at all, the gain occurs quite soon after insulin treatment has been started and then ceases. Careful attention to diet at the beginning of treatment, along with increasing levels of exercise, may prevent or minimize weight gain. However, it may be advisable for those with Type 2 diabetes to follow a weight loss diet from the start.
Other, rare, side-effects occasionally occur, including water retention affecting the feet and lower legs, deterioration in existing retinopathy (eye disease), and neuritis (painful inflammation of nerves). The first two are usually short-lived and subside and improve with time, but neuritis can be persistent and require more prolonged treatment of the symptoms.
Intensive Insulin Therapy in People with Type 1 Diabetes
Intensive insulin therapy, or 'tight' control, based upon a multiple injection/Basal Bolus regime, attempts to maintain blood glucose at near normal levels for most of the time. Research studies have shown that good control of gly-caemia, achieved through intensive insulin treatment, reduces the risk of microvascular complications of diabetes, namely, retinopathy, neuropathy and nephropathy. Also, when these complications are present, insulin therapy may in some cases slow their rate of progression. Unfortunately, these desirable outcomes are counter-balanced by a serious disadvantage, which is an increased incidence of severe episodes of hypoglycaemia, that is, attacks which require the intervention and assistance of other people. Further disadvantages are the need for a high degree of motivation on the part of the person concerned, in order to carry out frequent monitoring of blood glucose levels and to self-administer several injections each day.
From a clinical point of view, there are certain groups of people for whom intensive treatment with insulin is inadvisable. They include those who already experience episodes of severe hypoglycaemia and people who are unable to recognize or who do not experience the early-warning signs of an attack. It is also unsuitable for people with major or advanced tissue damage resulting from diabetic complications and those with heart disease or other serious conditions. Finally, intensive insulin therapy is unsuitable for children under the age of 13 because repeated episodes of hypoglycaemia can harm the developing brain.
Tight Control of Glycaemia in People with Type 2 Diabetes
Tight glycaemic control in Type 2 diabetes maybe achieved using sulphonylureas and/or insulin. Studies suggest that rigorous treatment for those with this syndrome results in a similar reduction in the risks posed by microvascular complications. Once again, the major disadvantage is an increased incidence of severe hypoglycaemia, as well as weight gain.
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