Treatment with Insulin

As has been described in a previous chapter, a large percentage of patients with diabetes can now be restored to normal blood sugars by watching their diet and taking appropriate tablets, without recourse to insulin. Nevertheless, there remains a type of diabetes which cannot be controlled without insulin. This is true of almost all cases of diabetes developing in children and in young adults. However, it is not only young diabetics who must be controlled with insulin and it is a mistake to assume that when diabetes develops in an older age it can necessarily be managed without insulin. Indeed, sometimes very elderly patients develop severe diabetes which does not respond to tablets and which cannot be controlled without insulin. In the main, patients who are underweight are unlikely to be controlled without insulin as are patients who show considerable acetone as well as sugar in the urine. The presence of acetone suggests a more serious derangement of metabolism and this is unlikely to be corrected by tablet treatment. Indeed, considerable amounts of acetone in the urine is perhaps the single most important indication for the need for insulin.