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Achieving A1C Target

Your patient has been taking metformin, glipizide, and a daily basal insulin dose (.85 U/kg/day). While his fasting glucose levels are on target, he has not yet been able to reach his individualized glycemic target of A1C<7%. In your discussion with him about the addition of a prandial insulin dose to his regimen, you compare and contrast his options. Compared to basal insulin alone, premixed insulins:

Correct

Correct Answer: A. Tend to lower A1c to a larger degree

 

Educational Critique: Compared to basal insulin alone, the premixed insulins tend to lower A1C to a more significant degree. However, their use has been associated with slightly increased rates of hypoglycemia and weight gain. Due to the fixed ratios of shorter-acting and longer-acting insulins in premixed insulins, individuals lose their ability to titrate their insulin needs to their meal size and timing. Thus, the premixed are more suitable for those who have a regular eating schedule and predictable meal size.  https://www.ncbi.nlm.nih.gov/books/NBK45604/

Incorrect