International Journal of Diabetes Research 2015, 4(1): 13-21 DOI: 10.5923/j.diabetes.20150401.03 A Survey Comparing the Management of Diabetes, Hypoglycaemia and Hyperglycaemia by Type 1 and Type 2 Insulin Users Joan Taylor 1 , Robert Gregory 2 , Ahmed Alsabih 3 , Mohamd Alblihed 4 , Paul Tomlins 1 , Tarsem Sahota 1,* 1 Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester, United Kingdom 2 Department of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom 3 Department of Physiology, College of Medicine & King Khalid University Hospital (KKUH), King Saud University, Riyadh, Kingdom of Saudi Arabia 4 College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia Abstract Aim: The opinions and attitudes of type 1 (T1) and type 2 (T2) insulin users toward their diagnosis, management, treatment and complications as a result of their diabetes were sought. Methods: A bottom-up survey design consisting of 66 open and closed questions was used to determine both positive and negative experiences of patients currently using insulin by injection only. Results: 707 insulin users (71% T1 and 29% T2) predominately from the UK completed the questionnaire. A comparison between T1 and T2 insulin users found that exercise, diet, BG testing and excursions from normoglycaemia were the most common source of difficulty amongst these insulin dependent patients. The majority of T1 participants were found to use a basal bolus insulin regimen (Lantus/Levemir and a short-acting insulin such as Novorapid®, Humalog® or Actrapid® but only 34% of T2 insulin users used a similar system with 35% using biphasic insulin aspart 30 (Novomix®) which may have due to lesser hypoglycaemic events. Conclusions: The results from this survey which focus on the common needs of insulin users show that careful follow-up after diagnosis, frequent testing and education about calorie turnover from intake and exercise are required for both T1 patients but more so for T2 patients whose needs become similar to those of T1 patients once they begin to inject insulin. Keywords Diabetes, Insulin users, Hypoglycaemia, Hyperglycaemia 1. Introduction About 366 million people have various common forms of diabetes, including lifestyle associated T2 (90% of the total) [1], with T1, gestational [2] and other minority diabetic conditions such as latent autoimmune diabetes of adults (LADA) and maturity onset diabetes of the young (MODY) accounting for the rest. This number is expected to rise by about 50% in the next 15 years, so that about 10% of the world’s population would experience diabetes in one form or the other [3]. Insulin remains the only effective treatment for regulation of glucose levels in T1 diabetes, although adjuncts such as anti-hypertensives and statins are now included to protect the cardiovascular system from other biochemical abnormalities. For T2, the combination of dietary control, metformin and sulphonylureas (such as * Corresponding author: ssahota@dmu.ac.uk (Tarsem Sahota) Published online at http://journal.sapub.org/diabetes Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved Gliclazide®) are common as a preventive therapy for metabolic derangement. Insulin is often added later in the progress of T2 disease (or if there has been a heart attack) and many authorities believe this is often done too late [4]. Diabetes produces changes in the body chemistry that lead to the loss of protein function throughout the tissues [5]. High blood glucose (BG) concentration glycates inappropriately and permanently to the amine groups in proteins leading to structural protein and enzyme changes in various tissues [6, 7]. Other biochemical dysfunctions and compensatory anomalies occur in concert. The result is a metabolic derangement of carbohydrate and lipid that underpins the development of some of the complications that develop in poorly controlled diabetes of either main type [8]. These complications are mainly cardiovascular, renal, ophthalmic and neurological but also include dental, infection-related and wound-healing difficulties all of which as expensive to treat. The best treatment for maintaining acceptable HbA1c values for T1 and T2 diabetes comes from frequent testing and insulin doses known as ‘intensive control’ [9]. The evidence has been available for more than twenty years but