In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy.

The goals of therapy should be individualized based on many factors, including age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life.

Initiation of Insulin

Insulin may be used as augmentation or replacement therapy. ADA and AACE/ACE guidelines for starting insulin therapy are summarized below.

BG = blood glucose; SMBG = self-monitoring of blood glucose; Replacement = Use of basal and bolus insulin to control blood glucose when endogenous insulin production is minimal or absent

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