The use of bolus insulin and advancing insulin therapy in type 2 diabetes

Karl, Diane M.

doi:10.1007/s11892-004-0037-1

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Basal insulin therapy may help patients achieve glycemic goals for a time, but predictable and progressive pancreatic β-cell dysfunction necessitates the eventual addition of mealtime insulin to minimize postprandial hyperglycemia 36,37. Glucose fluctuations during the postprandial period elicit more oxidative stress than chronic, sustained hyperglycemia, which can lead to endothelial dysfunction, vascular inflammation, atherosclerosis, and microvascular complications 38,39.…”

Section: Intensification Of Insulin Therapymentioning

confidence: 99%

Insulin initiation and intensification in patients with T2DM for the primary care physician

Unger¹

2011

DMSO

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Type 2 diabetes mellitus (T2DM) is characterized by both insulin resistance and inadequate insulin secretion. All patients with the disease require treatment to achieve and maintain the target glycosylated hemoglobin (A1C) level of 6.5%–7%. Pharmacological management of T2DM typically begins with the introduction of oral medications, and the majority of patients require exogenous insulin therapy at some point in time. Primary care physicians play an essential role in the management of T2DM since they often initiate insulin therapy and intensify regimens over time as needed. Although insulin therapy is prescribed on an individualized basis, treatment usually begins with basal insulin added to a background therapy of oral agents. Prandial insulin injections may be added if glycemic targets are not achieved. Treatments may be intensified over time using patient-friendly titration algorithms. The goal of insulin intensification within the primary care setting is to minimize patients’ exposure to chronic hyperglycemia and weight gain, and reduce patients’ risk of hypoglycemia, while achieving individualized fasting, postprandial, and A1C targets. Simplified treatment protocols and insulin delivery devices allow physicians to become efficient prescribers of insulin intensification within the primary care arena.

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Section: Intensification Of Insulin Therapymentioning

confidence: 99%

Insulin initiation and intensification in patients with T2DM for the primary care physician

Unger¹

2011

DMSO

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“…As diabetes is a progressive disorder, pancreatic β-cell dysfunction necessitates the addition of mealtime insulin to minimize postprandial excursions 15,16. Glucose fluctuations during the postprandial period elicit more oxidative stress than chronic, sustained hyperglycemia and can lead to endothelial dysfunction, vascular inflammation, and microvascular complication 17.…”

Section: Physiologic Insulin-replacement Therapy Overviewmentioning

confidence: 99%

Comparing the efficacy, safety, and utility of intensive insulin algorithms for a primary care practice

Unger

2011

Diab Ther

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Diabetes management is firmly based within the primary care community. Landmark randomized, controlled trials have demonstrated that even modest reductions in glycated hemoglobin (HbA1c) can yield improvements in economic and medical end-points. Diabetes is a chronic, progressive disease associated with loss of pancreatic β-cell function. Therefore, most patients will eventually require insulin therapies in order to achieve their individualized targeted HbA1c as their β-cell function and mass wanes. Although clinicians understand the importance of early insulin initiation, there is little agreement as to when to introduce insulin as a therapeutic option. Once initiated, questions remain as to whether to allow the patients to self-titrate their dose or whether the dosing should be tightly regulated by the clinician. Physicians have many evidence-based basal insulin protocols from which to choose, all of which have been shown to drive HbA1c levels to the American Diabetes Association target of ≤7%. This article will discuss ways by which insulin therapies can be effectively introduced to patients within busy primary care practices. Published evidence-based basal insulin protocols will be evaluated for safety and efficacy.

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“…For some patients with type 2 diabetes, it is common practice to use insulin analogues with basal and bolus regimens that are less complicated. For example, Karl [9] recommended using gradual introduction of mealtime rapid analogue insulin, starting with the major meal of the day and then advancing to other meals as needed based on postprandial monitoring. Data using frequent monitoring profi les and the continuous glucose monitoring system from Monnier et al [10,11] suggest that hyperglycemia after breakfast is the most pronounced of the day, followed by the evening meal.…”

Section: Medications Targeting Postprandial Glucosementioning

confidence: 99%

What are the best options for controlling prandial glycemia?

Clement

2009

Curr Diab Rep

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Epidemiologic studies suggest that postprandial hyperglycemia is more strongly linked to an increased risk for cardiovascular events than fasting or preprandial glucose levels. Although the results of prospective randomized studies proving causation of this finding are mixed, clinicians have given increased attention to target therapy to postprandial glucose than in the past. Rapid-acting insulin analogues, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and acarbose all target the postprandial glucose levels. This wide range of therapies allows the clinician to mix and match agents of different classes to target the fasting, preprandial, and postprandial glucose to optimize the daily glucose pattern and reduce the risk of diabetic complications.

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The use of bolus insulin and advancing insulin therapy in type 2 diabetes

Cited by 9 publications

References 28 publications

Insulin initiation and intensification in patients with T2DM for the primary care physician

Insulin initiation and intensification in patients with T2DM for the primary care physician

Comparing the efficacy, safety, and utility of intensive insulin algorithms for a primary care practice

What are the best options for controlling prandial glycemia?

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