title: Insulin initiation in type 2 diabetes: what are the treatment regimen options and how can we best help patients feel empowered?
abstract: OBJECTIVE
  This article summarizes treatment regimens and issues involved in initiating insulin therapy in type 2 diabetes (T2D). Progressive deterioration of beta-cell mass and function characterizes the course of T2D. Following diet and exercise, oral antidiabetic drugs (OADs), and incretin therapies, many patients require insulin, but initiation is often delayed until complications develop.
  
  
  METHODS
  Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information.
  
  
  CONCLUSIONS
  The diabetes nurse practitioner should encourage patients to initiate insulin when appropriate; patients need to know that this represents a natural step in treatment, not a personal failing. Initiation often occurs when OADs no longer confer adequate glycemic control. Treatment regimens available include once-daily basal insulin, sometimes with addition of prandial insulin, or premix/biphasic insulin. Insulin analogs confer less risk of hypoglycemia and weight gain, and greater dosing flexibility compared with conventional insulins. Insulin efficacy may be enhanced by continuing metformin and/or incretin therapies, while discontinuing other drugs as appropriate.
  
  
  CONCLUSIONS
  The well-versed diabetes nurse practitioner assists the patient in selecting the most appropriate option for his/her specific needs. It is essential to help patients overcome barriers, including fears of injection pain, public embarrassment, and hypoglycemia risk.
authors.affiliation: Yale Diabetes Center, Yale School of Medicine, New Haven, Connecticut 06519, USA. geralyn.spollett@yale.edu
authors.forename: Geralyn R
authors.initials: GR
authors.lastname: Spollett
mesh_terms: D000465:Algorithms; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D018450:Disease Progression; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054795:Incretins / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use; D009722:Nurse Practitioners; D017060:Patient Satisfaction; D011209:Power, Psychological; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D008687:Metformin