[Recommendations concerning the initial regimen and dose adjustments of insulin therapy for type 2 diabetes mellitus].
Although physicians are confronted with an increasing number of insulin-treated patients with type 2 diabetes mellitus, guidelines for the initial insulin regimen and dose adjustment are rare. If the fasting blood glucose level is > 10 mmol/l and the postprandial values are not much higher than the fasting ones, then the patient can be started on 8-12 IU of an intermediate-acting insulin before going to sleep. In the case of blood glucose levels which increase during the day or if a single insulin dose has insufficient effect, the patient can be started on a twice-daily administration of a premixed insulin. If more than 40 IU of insulin per injection are needed to regulate the blood glucose levels, it might be necessary to switch to administering insulin 4 times per day. Of this total daily quantity, initially 20% is administered as (ultra)short-acting insulin before the three daily meals and 40% as a bedtime intermediate-acting insulin. Occasionally elevated blood glucose levels do not necessarily have to be a reason for adjusting the insulin dosage.
Houweling
S T
ST
Isala Klinieken, locatie Weezenlanden, afd. Interne Geneeskunde, Postbus 10.500, 8000 GM Zwolle.
Timmerman
G J
GJ
Hoogstraten
M F M
MF
Ubink-Veltmaat
L J
LJ
Verhoeven
S
S
Bilo
H J G
HJ
D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D019518:Postprandial Period; D017410:Practice Guidelines as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin