title: Insulin tactics in type 2 diabetes.
abstract: Insulin is the most powerful glycemic control agent available. However, its use as a therapeutic modality requires education of the patient and regimentation of food intake, exercise, and frequent glucose monitoring. Such regimentation is particularly important when using a basal-bolus therapy approach. The introduction of many novel noninsulin drugs in the past decade has resulted in better glycemic control and often a need to reduce previously instituted insulin therapy. Although many of these novel therapies by themselves do not cause hypoglycemia, by reducing the overall glycemic burden through a myriad of mechanisms, they function in an insulin-sparing fashion. The doses of exogenously administered insulin may therefore need to be reduced in the presence of these new drugs to mitigate hypoglycemia. For insulin therapy (or any other drug treatment) to be successful, it is critical that the physician not only establish glycemic goals, but communicate these goals to the patient. The measurement of HbA1c helps in achieving a long-term goal, but on a day-today basis, patients need to be cognizant of their own BG goals and what they need to do if falling outside of target. The patients' understanding of self-management skills and empowerment are therefore foundational to insulin therapy.
authors.affiliation: Division of Endocrinology, Indiana University School of Medicine, 541 Clinical Drive, CL 365, Indianapolis, IN 46202, USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Meah
authors.affiliation: Division of Endocrinology, Indiana University School of Medicine, 541 Clinical Drive, CL 365, Indianapolis, IN 46202, USA. Electronic address: rajuneja@iu.edu.
authors.forename: Rattan
authors.initials: R
authors.lastname: Juneja
mesh_terms: D015190:Blood Glucose Self-Monitoring / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000379:methods; D015438:Health Behavior; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D000078790:Insulin Secretion; D010353:Patient Education as Topic; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Exogenous insulin profiles; Insulin adjustment; Insulin administration; Insulin secretion; Noninsulin therapy; Type 2 diabetes