ABSTRACT
Before the discovery of insulin, type 1 diabetes – where insulin deficiency can lead to ketoacidosis – was invariably fatal. Since the introduction of insulin, the therapeutic focus has broadened from treating and preventing diabetic ketoacidosis to preventing long-term vascular complications. Type 2 diabetes – where insulin resistance and a relative lack of insulin lead to hyperglycaemia – not only causes symptoms related directly to hyperglycaemia (polyuria, polydipsia and blurred vision – see below), but is also a very powerful risk factor for atheromatous disease. Glucose intolerance and diabetes mellitus are increasingly prevalent in affluent and developing countries, and represent a major public health challenge. Addressing risk factors distinct from blood glucose, especially hypertension, is of paramount importance and is covered elsewhere (Chapters 27 and 28). In this chapter, we focus mainly on the types of insulin and oral hypoglycaemic agents.
