Indications for insulin in Type 2 diabetes mellitus

Ensure that existing treatment is taken properly.

Insulin treatment should be considered in patients with inadequately controlled blood glucose levels - which is considered as a glycated haemoglobin (HbA1c) level of 7.5% or more (or a other higher level agreed with the individual) (1)

Other indications include:

• continued weight loss (even if insidious), persistent symptoms or both. The introduction of insulin therapy in these patients almost always results in substantial improvement in well-being
  
  
• in non-obese patients with poor diabetic control but without symptoms, whose weight is stable and who are conscientious with existing therapy
  
  
• obese patients without symptoms but whose weight is stable present a management dilemma: the correct therapy is intensification of diet - however a few of these patients will benefit from treatment with insulin. A three month trial of therapy with insulin can be a method of determining the efficacy of insulin in the individual patient
  
  
• often insulin therapy is required in patients with intercurrent illness. After recovery from the illness insulin therapy is withdrawn provided adequate control is achieved and maintained
  
  
• the development of hyperlipidaemia or early diabetic complications strengthens the decision to tighter control by starting insulin therapy
  
  
• if pregnancy is planned, patients are generally switched to insulin therapy

Reference:

• 1. National Institute for Health and Clinical Excellence (NICE) 2009. Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes
• 2. Prescribers' Journal (2000); 40 (1):38-48.