Intensifying insulin treatment: options, practical issues, and the role of the nurse practitioner

Journal of the American Academy of Nurse Practitioners
Davida F Kruger

Abstract

Failure to achieve and maintain glycemic targets in patients with type 2 diabetes (T2D) is a major clinical issue. Effectively combating the barriers that postpone timely intensification, and educating patients on available treatment options, are key roles of the nurse practitioner. This article summarizes practical considerations in the management of T2D at this stage. Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information. In patients receiving insulin therapy not achieving targets despite dose titration, a change in insulin regimen may be necessary to achieve clinical targets while minimizing hypoglycemia and weight gain. Whichever strategy is initiated first must be tailored to the individual and include on-going monitoring to manage both hyperglycemia and hypoglycemia. In addition to considerations of glycemic control, the timing and method of insulin intensification will depend on patient willingness, overall health status, meal patterns and routines, and risk of hypoglycemia. Common patient barriers to insulin intensification include regimen complexity and increased risk of hypoglycemia and weight gain. Support and education on available...Continue Reading

References

Jan 13, 2000·JAMA : the Journal of the American Medical Association·M O MundingerM L Shelanski
Sep 29, 2000·European Journal of Clinical Pharmacology·L V JacobsenA Riis
Oct 22, 2002·Nihon rinsho. Japanese journal of clinical medicine·Mitsuyoshi Namba
Sep 30, 2003·Diabetes Care·Rachel DerrChristopher D Saudek
Oct 14, 2004·JAMA : the Journal of the American Medical Association·Russell L RothmanMichael Pignone
Oct 19, 2004·European Journal of Endocrinology·A H Barnett
May 4, 2005·Journal of Diabetes and Its Complications·Irl B Hirsch, Michael Brownlee
Aug 18, 2006·Current Medical Research and Opinion·Massimo Massi-Benedetti
Mar 21, 2007·Journal of General Internal Medicine·Gregory A NicholsSonali N Shah
Sep 25, 2007·The New England Journal of Medicine·Rury R HolmanUNKNOWN 4-T Study Group
Nov 13, 2007·Patient Education and Counseling·Urmimala SarkarDean Schillinger
Jan 16, 2008·Annals of Family Medicine·Pamela A Ohman-StricklandBenjamin F Crabtree
Feb 15, 2008·Diabetes Care·Louis Monnier, Claude Colette
May 23, 2008·Diabetes Research and Clinical Practice·Matteo MonamiEdoardo Mannucci
Sep 12, 2008·The New England Journal of Medicine·Rury R HolmanH Andrew W Neil
Mar 10, 2009·Diabetes, Obesity & Metabolism·M MonamiE Mannucci
Sep 15, 2009·Diabetes Research and Clinical Practice·Leo NiskanenTero Saukkonen
Sep 29, 2009·International Journal of Clinical Practice·A G UnnikrishnanI Raz
Oct 24, 2009·The New England Journal of Medicine·Rury R HolmanUNKNOWN 4-T Study Group
Oct 28, 2009·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Helena W RodbardStanley S Schwartz
Nov 4, 2009·Journal of Diabetes Science and Technology·Louis MonnierDavid R Owens
May 27, 2010·Diabetes/metabolism Research and Reviews·Paolo PozzilliStefano Del Prato
Aug 18, 2010·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Robert J LigthelmPhilip Raskin

❮ Previous
Next ❯

Citations

May 18, 2012·Journal of the American Academy of Nurse Practitioners·Kathryn Tierney
May 18, 2012·Journal of the American Academy of Nurse Practitioners·Tom Bartol
May 18, 2012·Journal of the American Academy of Nurse Practitioners·Carolyn Robertson
Jul 30, 2015·Journal of Controlled Release : Official Journal of the Controlled Release Society·Moawia M Al-Tabakha

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.