Intensive Insulin Therapy in Type 2 Diabetes

Abstract

Exogenous insulin is eventually required in many patients with type 2 diabetes due to a progressive decline in pan- creatic γ-cell function. Insulin is usually initiated when other therapeutic modalities have failed to achieve glycemic control. Candidates for intensive management should be motivated, compliant, educable, and without other medical conditions and physical limitations that would preclude accurate and reliable monitoring and insulin administration. When combination therapy with a basal insulin plus oral antidiabetic drugs is not successful, therapy may be intensi- fied with a premixed or split-mixed regimen of intermediate- and fast-acting insulin equally divided between the pre- breakfast and predinner periods. For patients who do not achieve glucose control on combination basal or split-mixed regimens, an intensive basal-bolus multiple-injection regimen is indicated. Continuous SC insulin infusion pumps may be particularly useful in patients who do not respond satisfactorily to more conventional treatment strategies. Fast- acting insulin analogues should be used in the majority of patients requiring insulin because of their more physiologic pharmacokinetic profile. Inhaled insulin is a new alternative to SC insulin for patients with type 2 diabetes requiring insulin. (Insulin. 2007;2(Suppl B):$34-$40.