title: Methods to enhance delivery of prandial insulin and basal-prandial insulin.
abstract: Most physicians are comfortable with initiating basal insulin replacement therapy in their patients with type 2 diabetes who are no longer meeting treatment goals with oral antidiabetic agents. What is more challenging is what to do when treatment goals are no longer being met despite adequate titration of basal insulin. Both fasting plasma glucose and postprandial glucose contribute to hemoglobin A1C levels. Addressing postprandial glucose levels can be accomplished by several approaches. Traditionally this has meant moving to basal bolus insulin, which is considered the gold standard. Premixed insulin may also be used. Data is also emerging for basal "plus" strategies, that is, incremental addition of prandial insulin injections. Newer approaches also reviewed in this article included premixed formulations containing ultra-long acting basal insulin with rapid-acting insulin analogs, inhaled insulin and insulin jet injectors, as well as the use of incretin-based therapies.
authors: Department of Medicine, Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA. agarber@bcm.edu
authors: A J
authors: AJ
authors: Garber
mesh_terms: D000280:Administration, Inhalation; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D015195:Drug Design; D005215:Fasting / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D054795:Incretins / Q000627:therapeutic use; D007277:Injections, Jet; D007328:Insulin / Q000031:analogs & derivatives; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D061266:Insulin, Short-Acting / Q000008:administration & dosage*; D019518:Postprandial Period; D016032:Randomized Controlled Trials as Topic
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D049528:Insulin, Long-Acting; D061266:Insulin, Short-Acting