title: Intensifying insulin treatment: options, practical issues, and the role of the nurse practitioner.
abstract: OBJECTIVE
  Failure to achieve and maintain glycemic targets in patients with type 2 diabetes (T2D) is a major clinical issue. Effectively combating the barriers that postpone timely intensification, and educating patients on available treatment options, are key roles of the nurse practitioner. This article summarizes practical considerations in the management of T2D at this stage.
  
  
  METHODS
  Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information.
  
  
  CONCLUSIONS
  In patients receiving insulin therapy not achieving targets despite dose titration, a change in insulin regimen may be necessary to achieve clinical targets while minimizing hypoglycemia and weight gain. Whichever strategy is initiated first must be tailored to the individual and include on-going monitoring to manage both hyperglycemia and hypoglycemia. In addition to considerations of glycemic control, the timing and method of insulin intensification will depend on patient willingness, overall health status, meal patterns and routines, and risk of hypoglycemia. Common patient barriers to insulin intensification include regimen complexity and increased risk of hypoglycemia and weight gain.
  
  
  CONCLUSIONS
  Support and education on available treatment regimens are key to achieve a comfort level with intensifying insulin therapy that will lead to improved treatment adherence.
authors.affiliation: Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, Michigan 48202, USA. dkruger1@hfhs.org
authors.forename: Davida F
authors.initials: DF
authors.lastname: Kruger
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000451:nursing*; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D009722:Nurse Practitioners; D024802:Nurse's Role; D010353:Patient Education as Topic
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin