Application of Intensive Insulin Therapy, Chapter 9 – Part 3
Steve V. Edelman, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego
Robert R. Henry, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego
The goals of therapy should be individually tailored.
Candidates for intensive management should be:
In addition, caution is advised in patients who are elderly or who are unaware of the signs of hypoglycemia. Other limitations to achieving normoglycemia may include high titers of insulin antibodies, especially in those patients with a prior history of intermittent insulin use of animal origin. The site of insulin injection may also change the pharmacokinetics, and absorption can be highly variable, especially if lipohypertrophy is present. The periumbilical area has been shown to be one of the more desirable areas in which to inject insulin because of the rapid and consistent absorption kinetics observed at this location.
Prior to initiating insulin therapy, the patient should be well educated in the:
• Technique of SMBG
• Proper techniques of mixing insulins and administration
• Self adjustment of insulin dose if appropriate
• Dietary and exercise strategies.
The patient and family members also need to be informed about hypoglycemia prevention, recognition, and treatment. Initial and ongoing education by a diabetes management team is crucial for long-term success and safety.
There is no one insulin that fits all patients with insulin-requiring type 2 diabetes. There is a natural progression of regimens that can be used as a general algorithm when considering insulin therapy. Figure 9.3 demonstrates that when oral-agent therapy fails, an easy and often effective regimen can be combination therapy followed by a split-mixed regimen and then a basal bolus multiple-injection regimen.
© Copyright 2010. Steven V. Edelman, MD, Robert R. Henry, MD, Professional Communications, Inc. All rights reserved.
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