Type 2 diabetes mellitus--guidelines for initiating insulin therapy.
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.
Yeap
Bu Beng
BB
Department of Endocrinology and Diabetes, Fremantle Hospital, Western Australia, Australia. byeap@cyllene.uwa.edu.au
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
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin