KISS Keep Insulin Safe and Simple is a very practical and simple way to initiate insulin and achieve optimal glycaemic control in type 2 diabetic.

35. First commercial insulin

37. BANTING-1891-1941 & BEST-1899-1978 Orthopod who became a physiologist and died in air crash in Newfoundland while on wartime mission Together they isolated insulin and Banting won the Nobel Prize in 1923 knighted in 1934

54. Lower A1C level Reduces the Risk of Complications DCCT * KUMAMOTO * UKPDS Each 1% fall in A1C results in 20-30% RRR in microvascular compln

67. HbA 1c and Microvascular Complications Relative Risk 15 13 11 9 7 5 3 1 HbA 1c , % 7 8 9 10 11 12 Neuropathy Nephropathy Retinopathy

68. Every 1% HbA 1c Increase Above Goal Elevates the Risk of Diabetic Complications Increase in Any Diabetes-Related Endpoint Increase in Risk of Myocardial Infarction (MI) Increase in Risk of Stroke Increase in Risk of Microvascular Complications Incidence of Diabetes- Related Complications (%) +21% +37% +12% +14% Adapted from Stratton et al. BMJ . 2000;321:405-412.

69. Lower A1C level Reduces the Risk of Complications DCCT * KUMAMOTO * UKPDS Each 1% fall in A1C results in 20-30% RRR in microvascular compln

70. Good Glycemic Control (Lower HbA 1c ) Reduces Incidence of Complications DCCT Research Group. N Engl J Med . 1993;329:977-986. Ohkubo Y et al. Diabetes Res Clin Pract . 1995;28:103-117. UKPDS 33: Lancet . 1998;352:837-853. HbA 1c Retinopathy Nephropathy Neuropathy Macrovascular disease DCCT 9  7% 63% 54% 60% 41%* Kumamoto 9  7% 69% 70% – – UKPDS 8  7% 17-21% 24-33% – 16%* * not statistically significant

76. Chris Rhodes Ph.D. PNRI, Seattle, WA. TYPE 2 DIABETES – A QUESTION OF BALANCE PERIPHERAL INSULIN RESISTANCE BETA CELL MASS AND FUNCTION NON DIABETIC STATE BETA CELL MASS AND FUNCTION PERIPHERAL INSULIN RESISTANCE DIABETIC STATE

85. Lifestyle

86. The long term goal might be 30- 40 minutes or 10000 steps per day WALK MORE ,WALK EACH DAY AND WALK MORE EACH WEEK

88. Lifestyle

104. INSULIN SECRETION FAILS

107. FIRST PHASE INSULIN SECRETION

109. BETA CELL FUNCTION

111. T2DM –NATURAL HISTORY

124. Insulin Glargine : Structure Insulin Glargine : 21 A -Gly 30 B a-L-Arg-30 B b-L-Arg-insulin Metabolites : M1-21 A -Gly-insulin M2-21 A -Gly-des-30 B -Thr-insulin Substitution Extension A-chain B-chain 1 5 10 15 20 Asn 1 5 10 15 20 25 30 Arg Arg Gly

139. INITIATION&TITRATION

156. Sweet food

157. Sweet food

158. Fat food

159. Meat

162. Cereals

163. Vegetables

164. Vegetables

165. Raw vegetables

166. Vegetables

167. Vegetables

168. Fish

181. INSULIN Rx PROGRAM

197. INSULIN IS NOT……

203. THANK YOU THANK YOU VERY MUCH