title: Type 2 diabetes mellitus--guidelines for initiating insulin therapy.
abstract: BACKGROUND
  Insulin is often indicated for patients with suboptimally controlled type 2 diabetes mellitus, despite lifestyle modification and oral antidiabetic agents.
  
  
  OBJECTIVE
  This article outlines the initiation of insulin therapy for patients with type 2 diabetes in the general practice context.
  
  
  CONCLUSIONS
  Insulin initiation options are bed time basal insulin (NPH, glargine) 10 U for patients with fasting hyperglycaemia, or twice daily premixed insulin (eg. aspart 30%/NPH 70%) 6-10 U twice per day targeting day time or postprandial hyperglycaemia. Basal insulin should be titrated regularly on a prophylactic basis (eg. fasting glucose <4.4 mmol/L: -2U, 4.4-7.0: +0 U, 7.1-10.0: +2 U, >10.0: +4 U) or increased by 1 U/day until fasting glucose of 5.5 mmol/L is reached. HbA1c changes of -1.5 to -2.5% are achievable with potential weight gain around 3 kg over 6 months. Approximately 50% of patients can achieve HbA1c <or=7% with insulin doses around 40-70 U/day. Glitazones are an alternative to insulin, but for HbA1c, >or=9.5% insulin results in greater improvement in fasting glucose and HbA1c. Patients require education for blood glucose monitoring, healthy diet, exercise and identifying and responding to hypoglycaemia.
authors.affiliation: Department of Endocrinology and Diabetes, Fremantle Hospital, Western Australia, Australia. byeap@cyllene.uwa.edu.au
authors.forename: Bu Beng
authors.initials: BB
authors.lastname: Yeap
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D017410:Practice Guidelines as Topic
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin