Insulin therapy for type 2 diabetes.
Type 2 diabetes is a disease of insulin deficiency along with insulin resistance, and the natural history is a progressive worsening of insulin secretion over time. The obvious conclusion supported by clinical experience is most patients will eventually need insulin therapy. However, there is often a reluctance on the part of many care providers to prescribe insulin because of fears of weight gain, hypoglycemia, or cardiovascular consequences, or because the patient is unwilling. Another problem is many practitioners are uncertain how to use insulin in type 2 diabetes. This review discusses the benefits of insulin therapy in patients with type 2 diabetes when it is required for optimal glycemia control. It also debunks the fears over unwanted consequences such as severe hypoglycemia and worsening of atherosclerotic cardiovascular disease. Finally, it provides a "hands on" approach on how to start basal insulin therapy and multishot insulin therapy in type 2 diabetes.
Sasali
Afshin
A
Division of Endocrinology, Diabetes and Metabolism, and the Department of Medicine, University of Vermont College of Medicine, Given C-331, Burlington, VT 05405, USA.
Leahy
Jack L
JL
D001161:Arteriosclerosis / Q000139:chemically induced; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000139:chemically induced; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007333:Insulin Resistance; D015430:Weight Gain
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin