Introduction of insulin regime

Some regimens which might be useful in the introduction of insulin to the therapaeutic regimen include (1):

• basal insulin
  • adding a basal regimen to the current oral hypoglycaemic agents will result in suppressing the hepatic output of glucose and also a reduction in fasting glucose levels (1)
    • examples of insulin regimens which can be used with oral hypoglycaemics:
      • once daily intermediate acting insulin at bed time - useful in patients with high overnight and morning blood glucose which reduces once they start their normal daily work (2)
      • long acting insulin (taken at the same time, any time of the day, at 24-hour intervals) - useful in patients with high blood glucose during the day and night who otherwise will require twice daily basal insulin injections (2)
      • not useful in controlling post prandial glucose increase (1)
  • basal insulin together with oral hypoglycaemias is useful in the following:
    • obese and insulin resistant patients
    • people who hesitate to start insulin e.g - due to needle phobia
    • people who are unable to inject themselves
    • in people whom hypoglycaemia is unacceptable but optimal control is not very important e.g - elderly people without any complications or undue symptoms
• premix insulin
  • the aim of premix insulin regimen is to mimic the normal insulin secretion which consists of basal insulin and meal-time bolus insulin
  • aims to control both fasting and post-prandial hyperglycaemia (1)
  • is useful in patients who:
    • have a fairly routine lifestyle who have similar amounts of food at same time each day
    • are becoming insulin depleted and oral hypoglycaemics are no longer effective (2)
• basal bolus insulin
  • closely match the physiological insulin release, requires basal insulin with bolus or prandial rapid-acting insulin (generally requires four daily injections - a basal insulin injection plus rapid-acting insulin injections at meal-times)
  • it gives more flexibility since patients do not need to be on a strict meal time and the doses of insulin can be adjusted according to the content and quantity of the meal
  • is suitable for - young adults who require insulin, active sportsmen and pregnant women (1)
  • is useful in patients who:
    • needs flexibility e.g. - shiftwork, regular traveling across time zones
    • needs optimal control due to complications, illness or a wound (2)

Reference:

• 1. Joshi S, Joshi P. A review of insulin and insulin regimens in type 2 diabetes. SA Fam Pract 2009;51(2):97-102
• 2. Royal College of Nursing 2006. Starting insulin treatment in adults with type 2 diabetes.