Insulin Initiation in Patients with Type 2 Diabetes

Insulin initiation and titration is a challenge for many primary care providers (PCPs) involved in the treatment of patients with type 2 diabetes. 

What are ADA recommendations?

The early introduction of insulin should be considered -

·        if there is evidence of ongoing catabolism (weight loss),

·        if symptoms of hyperglycemia are present, or

·        when A1C levels (>10% [86 mmol/mol]) or

·        blood glucose levels (≥300 mg/dL [16.7 mmol/L]) are very high.

If the A1C target is not achieved after approximately 3 months, Metformin can be combined with any other oral hypoglycemic agent or Basal insulin; the choice of which agent to add is based on drug-specific effects and patient factors.

·        Control of fasting glucose can be achieved with human Intermediate acting NPH basal insulin (Insulin Human N) or a Long-acting basal insulin analog (Glargine, Detemir, Degludec).

Note: Initiation of basal insulin at 10 units/day or 0.1–0.2 units/kg/day, adjusted by 10–15% or 2–4 units once or twice weekly to reach a target fasting plasma glucose (FPG) in patients whose A1C remains uncontrolled after >3 months of triple combination therapy.

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