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 of less than 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:
Answer: A. tend to lower A1c to a larger degree.
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.
Inzucchi S, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6):1364-1379.