Feature Article

KISS: ‘keep insulin safe and simple’ Part 4: titrating insulin in type 2 diabetes

Feature Article

KISS: ‘keep insulin safe and simple’ Part 4: titrating insulin in type 2 diabetes

Pat Phillips

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Abstract

This last article in a short series on insulin therapy in type 2 diabetes uses a case study approach to discuss the typical progession of insulin therapy in type 2 diabetes, and offers advice on titrating insulin to keep blood glucose levels and A1c on target.

Key Points

  • About 50% of patients with type 2 diabetes will require insulin within six years of diagnosis.
  • Most people with type 2 diabetes begin insulin therapy with one daily dose of basal insulin and continue taking oral hypoglycaemic agents. As the diabetes progresses, it becomes necessary to introduce a second daily dose of basal insulin, and then doses of bolus insulin at mealtimes.
  • A somewhat simplified protocol for insulin therapy is to: first fix the fasting blood glucose level (BGL) (is bedtime basal insulin needed?); then tackle the evening BGL (is breakfast basal insulin needed?); treat any high postprandial BGLs (is a breakfast, lunchtime or teatime bolus insulin needed?); and check the A1c (is the A1c on target, or are there hidden hyperglycaemic episodes in the late morning, in the evening or at night?)