ABSTRACT
When insulin secretion becomes insufficient
to compensate for insulin resistance,
administration of exogenous insulin may be
the only solution to protect against severe
hyperglycaemia125-127 (Figure 2.5). However,
even if insulin can improve glycaemic control,
it is rarely effective in achieving tight
glycaemic control, despite increases in
resource use.128 In addition, high doses are
usually required in obese diabetic patients,
and there is a risk of a substantial increase in
body weight, unless there is good dietary
compliance.129 The mechanisms involved may
include reduced energy loss through
glycosuria, undetected mild hypoglycaemia,
primary stimulation of appetite, enhancement
of lipogenesis and a reduction in some
components of energy expenditure (reviewed
in reference 125).
