Effective switch from premixed to basal-prandial insulin to achieve glycemic goals in type 2 diabetes.
OBJECTIVE
This article describes a patient with type 2 diabetes mellitus achieving glycemic control after transitioning from premixed to basal-prandial insulin.


METHODS
A case report illustrates the challenges of achieving glycemic control in type 2 diabetes, and results of a literature search regarding premixed and basal-prandial insulins are presented.


RESULTS
A 52-year-old obese man with type 2 diabetes for 10 years initiated therapy with 2 oral antidiabetic drugs (OADs). When OAD therapy no longer maintained glycemic targets, and the addition of exenatide proved intolerable, he started premixed insulin aspart 70/30. However, lapses in exercise and irregular meal patterns led to a loss of glycemic control and nocturnal hypoglycemia. Switching to a basal-prandial regimen, starting with basal insulin glargine and then adding prandial insulin glulisine, subsequently resulted in a glycated hemoglobin level of 6.7%.


CONCLUSIONS
The patient benefited from the addition of 1 or more prandial insulin injections to a once-daily basal insulin analog.
Lavernia
Frank
F
North Broward Diabetes Center, Pompano Beach, FL 33064, USA. diabetescontrol@aol.com
D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D009765:Obesity / Q000209:etiology
D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D008687:Metformin