Diabetes:

Insulin

Fred Banting was taking the maximum dose of his current oral diabetic medication, however, his blood
glucose results were still ranged from 10-14 mmol/L. A HbA1c reading of 8.9% suggests poor glycaemic
control. The advantages and disadvantages of the 4 alternatives, acarbose, DPP-4, glitazones, and insulin
were discussed, and insulin was decided to be the most appropriate option (RACGP, p39). As the
preferred regimen for commencing insulin in patients with type 2 diabetes is once daily basal insulin
(eTG, Insulin), Lantus Solastar sc mdu, was prescribed by the doctor 6 weeks later. The initial dose for an
intermediate or long-acting is 10-12 units sc as the starting dose at bedtime with metformin and
sulfonylurea continued at previous dosages. After commencing insulin treatment, the insulin dose
should be increased 2-4 units every week until a pre breakfast reading of 4-6 mmol/L is achieved (eTG,
Insulin). If once daily insulin does not achieve 4-6 mmol/L glucose concentrations, options include twice
daily premixed insulin, twice daily basal insulin or adding bolus insulin to each meal as an intensive
regimen.