Insulin initiation in type 2 diabetes: what are the treatment regimen options and how can we best help patients feel empowered?

Journal of the American Academy of Nurse Practitioners
Geralyn R Spollett

Abstract

This article summarizes treatment regimens and issues involved in initiating insulin therapy in type 2 diabetes (T2D). Progressive deterioration of beta-cell mass and function characterizes the course of T2D. Following diet and exercise, oral antidiabetic drugs (OADs), and incretin therapies, many patients require insulin, but initiation is often delayed until complications develop. Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information. The diabetes nurse practitioner should encourage patients to initiate insulin when appropriate; patients need to know that this represents a natural step in treatment, not a personal failing. Initiation often occurs when OADs no longer confer adequate glycemic control. Treatment regimens available include once-daily basal insulin, sometimes with addition of prandial insulin, or premix/biphasic insulin. Insulin analogs confer less risk of hypoglycemia and weight gain, and greater dosing flexibility compared with conventional insulins. Insulin efficacy may be enhanced by continuing metformin and/or incretin therapies, while discontinuing other drugs as appropriate. The well-versed diabetes nurse practitioner assi...Continue Reading

References

Jul 1, 1992·Diabetes Care·M I HarrisM W Knuiman
Sep 1, 1990·Diabetes Care·J BrangeA Vølund
Jan 4, 1997·Lancet·A H Barnett, D R Owens
Feb 1, 1997·Postgraduate Medicine·J R WhiteI Hirsch
Jul 1, 1997·Diabetologia·J Brange
Apr 30, 1999·Diabetes Research and Clinical Practice·H Overmann, L Heinemann
Jun 6, 2000·Advanced Drug Delivery Reviews·J Brange, A Vølund
Sep 12, 2000·Lancet·G B Bolli, D R Owens
Aug 14, 2002·International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity·M Korytkowski
Aug 14, 2002·International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity·M Marre
Oct 22, 2002·Nihon rinsho. Japanese journal of clinical medicine·Mitsuyoshi Namba
May 8, 2003·JAMA : the Journal of the American Medical Association·Dawn E DeWitt, Irl B Hirsch
Oct 28, 2003·Diabetes Care·Matthew C RiddleUNKNOWN Insulin Glargine 4002 Study Investigators
Mar 12, 2004·The American Journal of Medicine·Matthew C Riddle
Apr 21, 2004·The Diabetes Educator·Martha M FunnellMary Spencer
Aug 17, 2004·The Medical Clinics of North America·Ralph A DeFronzo
Sep 14, 2004·Pharmaceutical Research·Svend HavelundPeter Kurtzhals
Nov 10, 2004·Diabetes Research and Clinical Practice·K RaslováN Hâncu
Nov 25, 2004·Diabetes·Martin KrssakMichael Roden
Dec 24, 2004·Diabetes Care·George E Dailey
Mar 1, 2005·Diabetes Care·William H PolonskyRichard A Jackson
May 4, 2005·Journal of Diabetes and Its Complications·Irl B Hirsch, Michael Brownlee
Sep 28, 2005·Diabetes Care·William H PolonskySteven V Edelman
Jan 28, 2006·The Diabetes Educator·Jerry Meece
Feb 2, 2006·Expert Opinion on Pharmacotherapy·Philip Home, Peter Kurtzhals
Mar 8, 2006·Clinical Therapeutics·Mary KorytkowskiToshinari Asakura
Jul 13, 2006·The Diabetes Educator·Stephen N Davis, Susan M Renda
Jul 19, 2006·Annals of Internal Medicine·Arshag D MooradianStewart G Albert
Dec 15, 2006·Nature·Steven E KahnKristina M Utzschneider
Mar 21, 2007·Journal of General Internal Medicine·Gregory A NicholsSonali N Shah
May 12, 2007·Journal of Diabetes and Its Complications·William Duckworth, Stephen N Davis

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Citations

May 18, 2012·Journal of the American Academy of Nurse Practitioners·Davida F Kruger
May 18, 2012·Journal of the American Academy of Nurse Practitioners·Tom Bartol
Sep 3, 2016·Diabetic Medicine : a Journal of the British Diabetic Association·H W RodbardUNKNOWN Dual Action of Liraglutide and insulin degludec (DUAL) IV trial investigators
May 18, 2012·Journal of the American Academy of Nurse Practitioners·Carolyn Robertson
May 18, 2012·Journal of the American Academy of Nurse Practitioners·Kathryn Tierney
Jan 17, 2017·Journal of Diabetes Research·Włodzimierz ŁuczyńskiArtur Bossowski

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