Insulin: The physiological basis of its administration

Abstract

Diabetes is a disease of absolute or relative insulin deficiency which may be accompanied by a variety of pathological tissue complications. These tissue complications are much rarer in non-diabetic subjects and it is therefore reasonable to assume that they are secondary to “failure” of the normal physiological homeostatic mechanisms. Such a failure is not, however, straightforward, and the markers of what we mean by “failure” are unclear. For instance, although studies have shown that complications are more likely in those with hyperglycaemia (1,2) and with longer duration (3), such findings are statistical and not absolute. Sane patients may survive many years with poor control and have no complications at all. There may also be genetic susceptibility to complications as well as to developing diabetes (4), and our tendency to concentrate on hyperglycaemia as an index of poor control may be misguided. Many other body metabolites may be affected (5) and insulin itself may have adverse effects when given in inappropriate quantities, even when approximate normoglycaemia is achieved (6).