Insulin use in patients with diabetes and tuberculosis
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 3
Abstract
Current estimates from the World Health Organisation (WHO) suggests that 15% of patients of with tuberculosis infection have the additional double burden of diabetes mellitus. Control of hyperglycaemia among these patients is as important as anti-tubercular therapy. Though there are currently no randomised studies to suggest insulin therapy has better outcomes in comparison to oral anti-diabetic therapy among these patients, there are plenty of historical and clinical data to suggest that insulin therapy is a superior choice. Historically within a year of the availability of insulin commercially in 1923, physicians in Europe and America started using insulin among patients with tuberculosis and normal glucose tolerance. This was primarily for its benefits in improving appetite, augmenting weight gain and improving strength. Though this is currently not indicated the historical advantages of insulin continue to serve patients with co-existing diabetes mellitus and tuberculosis. Insulin therapy has no drug interactions with the currently used first and second line anti-tubercular agents unlike oral anti-diabetic drugs. In patients with liver and renal dysfunction, in-sulins remain the drug of choice. Patients with significant hyperosmolar symptoms, weight loss, HbA1c >9%, fasting plasma glucose >250mg/dl and those who are catabolic with poor appetite insulin is absolutely indicated as the therapy of choice for their diabetes
Authors and Affiliations
Abraham Alex Kodiatte, Jubbin Jagan Jacob
Keywords
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