Type 2 Diabetes Mellitus: Outpatient Insulin Management

August 23, 2018

Type 2 Diabetes Mellitus: Outpatient Insulin Management

When the A1C level is 9% or more, the American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy in patients taking one or two oral agents, or one oral agent, plus a glucagon-like peptide 1 receptor agonist. This is especially true if the patient has symptoms of hyperglycemia or catabolism.
Benefits of insulin therapy:

  • Insulin therapy is one of the most potent antihyperglycemic agents available.
  • Early intervention with insulin reduces both macrovascular and microvascular complications.

Concerns about insulin therapy:

  • Weight gain is a concern when initiating insulin therapy. Therefore, it is recommended to remove any oral medications that are associated with weight gain (SU, TZDs, and Meglitinides), when starting patients on insulin therapy.
  • Hypoglycemia is a concern for patients beginning insulin therapy; about 10% will experience one hypoglycemic event.  Current guidelines recommend slow titration of insulin regimens, every two to four days, until self-monitored blood glucose targets are achieved.

Insulin analogs have a lower risk of hypoglycemia than human insulin, but at a higher cost – Please click here for more information.
An overview of Lantus, Toujeo, Basaglar and Tresiba is found on page 35 of the above referenced article. Please note: the article mentions Ryzodeg, which has not been launched in the United States.

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