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Insulin plays an important role in maintaining blood glucose at a healthy level. Due to reduced production and/or inefficient use of insulin (i.e. insulin resistance), individuals diagnosed with type 2 diabetes mellitus (TZDM) often require insulin injections (Diabetes Australia, 2020). The total utility of insulin injections for an individual starting insulin is illustrated in Figure 1 (below). At first, an individual may experience disutility due to pain/discomfort at the injection site, inconveniences (e.g. planning meals around timing and dose of injection), hypoglycaemia or weight gain. For many individuals, it takes time to find the right insulin dose and for blood glucose levels to improve. As such, the marginal utility will increase while the negative utility is slowly offset by positive utility (e.g. improvements in mood and energy). Total utility of insulin injections short term Units of utility |' N 0-) -b U1 0' O O O O O O O 1 2 3 4 5 Quantity of insulin Figure 1. Total utility of insulin injections in the short term For an individual that has been using insulin for many years, the total utility may differ as illustrated in Figure 2 (below). The individual may derive less benefit from ongoing use of insulin, particularly so if blood glucose levels are maintained at a healthy level. Possible reasons for diminishing marginal utility include; improved lifestyle (e.g. weight loss, healthy eating habits, more physically active) as a result of education usually received with insulin prescription and improved health (e.g. prevention of further chronic conditions that usually develop from hyperglycaemia such as neuropathy, diabetic nephropathy or retinopathy, etc.). In other scenarios, diminishing marginal utility may be a consequence of declining health (i.e. insulin resistance), whereby frequent injections may be needed but only bring about small improvements in health (e.g. ability to lower blood glucose becomes more and more impaired). Total utility of insulin injections - long term Units of utility l' H N N O U1 0 U1 DU! 1 2 3 4 5 Quantity of insulin Figure 2. Total utility of insulin injections in the long term Stephanie Moriarty