Home Forums General Medicine DM TYPE 2-CHAPTER- INSULIN OPTIONS

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    Anonymous
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    Insulin-based treatments

    When starting insulin therapy in adults with type 2 diabetes, use a structured programme employing active insulin dose titration that encompasses:
    injection technique, including rotating injection sites and avoiding repeated injections at the same point within sites

    continuing telephone support

    self-monitoring

    dose titration to target levels

    dietary understanding

    DRIVING LICENCE GUIDANCE

    management of hypoglycaemia

    management of acute changes in plasma glucose control

    support from an appropriately trained and experienced healthcare professional.

    When starting insulin therapy in adults with type 2 diabetes, continue to offer metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies.

    Start insulin therapy for adults with type 2 diabetes from a choice of a number of insulin types and regimens:
    Offer NPH insulin injected once or twice daily according to need.

    Consider starting both NPH and short?acting insulin (particularly if the person’s HbA1c is 75 mmol/mol [9.0%] or higher), administered either:

    separately or

    as a pre-mixed (biphasic) human insulin preparation.

    Consider, as an alternative to NPH insulin, using insulin detemir or insulin glargine if:

    the person needs assistance from a carer or healthcare professional to inject insulin, and use of insulin detemir or insulin glargine[8] would reduce the frequency of injections from twice to once daily or

    the person’s lifestyle is restricted by recurrent symptomatic hypoglycaemic episodes or

    the person would otherwise need twice?daily NPH insulin injections in combination with oral glucose?lowering drugs.

    Consider pre-mixed (biphasic) preparations that include short?acting insulin analogues, rather than pre?mixed (biphasic) preparations that include short?acting human insulin preparations, if:

    a person prefers injecting insulin immediately before a meal or

    hypoglycaemia is a problem or

    blood glucose levels rise markedly after meals.

    Consider switching to insulin detemir or insulin glargine from NPH insulin in adults with type 2 diabetes:
    who do not reach their target HbA1c because of significant hypoglycaemia or

    who experience significant hypoglycaemia on NPH insulin irrespective of the level of HbA1c reached or

    who cannot use the device needed to inject NPH insulin but who could administer their own insulin safely and accurately if a switch to one of the long?acting insulin analogues was made or

    who need help from a carer or healthcare professional to administer insulin injections and for whom switching to one of the long?acting insulin analogues would reduce the number of daily injections.

    Monitor adults with type 2 diabetes who are on a basal insulin regimen (NPH insulin, insulin detemir or insulin glargine, for the need for short?acting insulin before meals (or a pre?mixed [biphasic] insulin preparation).

    Monitor adults with type 2 diabetes who are on pre?mixed (biphasic) insulin for the need for a further injection of short?acting insulin before meals or for a change to a basal bolus regimen with NPH insulin or insulin detemir or insulin glargine, if blood glucose control remains inadequate.

    G .MOHAN

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