Average Insulin Dose For Type 2 Diabetes – Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance and progressive beta cell failure in muscle, liver, and adipocytes.
Beta cell failure progresses at a rate of approximately 4% per year, often requiring the use of multiple medications, including insulin, to achieve and maintain glycemic control.
- 1 Average Insulin Dose For Type 2 Diabetes
- 1.1 Initiating Insulin For People With Type 2 Diabetes
- 1.2 Initiating Insulin In Patients With Type 1 Diabetes
- 1.3 Efficacy And Safety Of Self Titration Algorithms Of Insulin Glargine 300 Units/ml In Individuals With Uncontrolled Type 2 Diabetes Mellitus (the Korean Titration Study): A Randomized Controlled Trial
- 1.4 New Recommendations For Hba1c Targets For Type 2 Diabetes
- 2 Diabetic Ketoacidosis (dka)
- 3 Update On Type 2 Diabetes Mellitus And Older Adults
- 3.1 Type 2 Diabetes Management Toolbox: From Lifestyle To Insulin
- 3.1.1 Tirzepatide Versus Semaglutide Once Weekly In Patients With Type 2 Diabetes
- 3.1.2 Once Weekly Tirzepatide Versus Once Daily Insulin Degludec As Add On To Metformin With Or Without Sglt2 Inhibitors In Patients With Type 2 Diabetes (surpass 3): A Randomised, Open Label, Parallel Group, Phase 3 Trial
- 3.1.3 Complementary Approaches To Improving Glucose Control—insulin And Incretins: Patient Case Studies In Action
- 3.1 Type 2 Diabetes Management Toolbox: From Lifestyle To Insulin
Average Insulin Dose For Type 2 Diabetes
Data from the National Health and Nutrition Examination Survey shows that US adults with diabetes The percentage of adults with an A1C level greater than 9% decreased slightly between 2003 to 2006 and 2007 to 2010, from 13% to 12.6% (relative risk reduction = 3. %; 95% confidence interval, −3.8% to −3.0 %).
Initiating Insulin For People With Type 2 Diabetes
According to the Centers for Disease Control and Prevention, from 2010 to 2012, 57% of patients with type 2 diabetes used only oral diabetes medications.
Thus, it is likely that many patients who should receive insulin therapy do not. American Family Physician recently published a review of non-insulin therapies for type 2 diabetes.
When treating patients with insulin therapy for type 2 diabetes mellitus, physicians should minimize the use of concomitant medications that may cause weight gain.
Consider initiating basal insulin to augment therapy with one or two oral agents or one oral agent plus a GLP-1 receptor agonist when A1C is 9% or greater, especially if symptoms of hyperglycemia or catabolism are present. Or, consider adding basal insulin to augment therapy with two oral agents with or without a GLP-1 receptor agonist when A1C is greater than 8%.
Initiating Insulin In Patients With Type 1 Diabetes
Consider starting insulin replacement therapy when blood glucose levels are 300 to 350 mg per dL (16.7 to 19.4 mmol per L) or higher or when A1C is greater than 10% to 12%. Also consider adding rapid-acting insulin in patients taking basal insulin who are already on augmentation therapy but cannot achieve A1C goals.
A1C goals should be individualized based on age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, adverse outcomes related to hypoglycemia, or patient motivation and compliance.
Intensive control of type 2 diabetes (A1C goal below 7%) significantly reduces the need for photocoagulation treatment of diabetic retinopathy but increases the risk of hypoglycemia and death.
American Diabetes Association (ADA) guidelines and American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) guidelines suggest minimizing the use of concomitant medications that may cause weight gain when treating patients with type 2 diabetes.
Efficacy And Safety Of Self Titration Algorithms Of Insulin Glargine 300 Units/ml In Individuals With Uncontrolled Type 2 Diabetes Mellitus (the Korean Titration Study): A Randomized Controlled Trial
Based on expert opinion, long-acting (basal) insulin with a peptide 1 (GLP-1) receptor agonist such as metformin, pramlintide (Symlin), or glucagon is better for weight loss in obese patients than basal insulin alone. or combined with a sulfonylurea.
Hypoglycemia can be caused by a mismatch between insulin and carbohydrate intake, exercise, or alcohol consumption. Concerns about the risk of hypoglycemia may prevent or delay initiation or intensification of insulin therapy.
Among patients taking insulin, 7% to 15% experience at least one episode of hypoglycemia per year, and 1% to 2% have severe hypoglycemia (ie, requiring assistance from others for treatment). Hypoglycemia is associated with poor outcomes and high rates of death, particularly in elderly patients.
Patients with type 2 diabetes and a history of at least one severe hypoglycemic event have an approximately two- to fourfold higher mortality rate than patients without a severe event.
New Recommendations For Hba1c Targets For Type 2 Diabetes
All patients should be educated about the symptoms and self-treatment of hypoglycemia. The ADA recommends the following: (1) check blood glucose levels if signs or symptoms of hypoglycemia are present; (2) if the blood glucose level is less than 70 mg per dL (3.9 mmol per L), treat with 15 grams of fast-acting carbohydrate, such as 4 ounces of fruit juice, or three or four glucose tablets; and (3) recheck after 15 minutes to ensure blood glucose levels have returned to normal.
In addition, the ADA suggests that all patients with one or more episodes of severe hypoglycemia may benefit from a short-term relaxation of glycemic targets.
Very complex/poor health (long-term care, terminal chronic illnesses, ‡ moderate to severe cognitive impairment, or 2 or more ADL impairments)
Insulin may be used as augmentation or replacement therapy. ADA and AACE/ACE guidelines for initiating insulin therapy are summarized in Figure 1.
Introducing Insulin Into Diabetes Management: Transition Strategies For Older Adults: Journal Of Gerontological Nursing: Vol 37, No 4
Add prandial insulin before each meal: total daily dose 0.3 to 0.5 units per kg and split 50% basal and 50% prandial†
Use of basal or bolus insulin to help improve glucose control in patients with partial beta cell failure
Use of basal and bolus insulin to control blood glucose when endogenous insulin production is minimal or absent
The number of units of insulin needed to cover a certain gram of carbohydrates
Diabetic Ketoacidosis (dka)
How much 1 unit of insulin is expected to reduce the patient’s blood glucose level; When blood glucose levels are above predetermined targets, short-acting insulin can be added to bolus doses or given separately between meals.
Augmentation therapy with basal insulin can be initiated at 10 units once daily or using weight-based dose calculations.
The ADA recommends the use of basal insulin to augment therapy with one or two oral agents or one oral agent plus a GLP-1 receptor agonist when the A1C is 9% or greater, especially if the patient has symptoms of hyperglycemia or catabolism.
The AACE/ACE guidelines recommend adding basal insulin to augment therapy with two oral agents with or without a GLP-1 receptor agonist when A1C is greater than 8%.
Update On Type 2 Diabetes Mellitus And Older Adults
The ADA also recommends basal insulin with other agents when the A1C is greater than 9% at diagnosis and the patient has symptoms of hyperglycemia.
The ADA prescribes insulin replacement therapy with basal and rapid-acting prandial (basal-bolus) insulin when blood glucose levels are 300 to 350 mg per dL (16.7 to 19.4 mmol per L) or higher or A1C is greater than 10%. 12%. Insulin replacement therapy may also be considered in patients with newly diagnosed type 2 diabetes and elevated blood glucose or A1C and hyperglycemic symptoms.
In patients already receiving insulin augmentation therapy who do not meet A1C goals, the AACE/ACE guidelines suggest adding rapid-acting prandial insulin.
Insulin analogs are as effective as human insulin in lowering A1C levels with a lower risk of hypoglycemia, but they cost significantly more.
Type 2 Diabetes Management Toolbox: From Lifestyle To Insulin
The long-acting insulin analogs detemir (Levemir) and glargine (Lentus) isophane (NPH; Humulin N) cause significantly fewer nocturnal hypoglycemic events than human insulin.
The rapid-acting insulin analogs aspart (Novolog), glulisine (Epidra), and lispro (Humalog) have been associated with a small but statistically significant reduction in hypoglycemic events compared with regular human insulin.
The ADA recommends that the insulin regimen be adjusted once or twice a week (or every three or four days) until the self-monitoring of blood glucose (SMBG) goal is achieved.
Show different approaches to insulin titration based on the type of insulin used and the resulting SMBG readings. It should be noted that these recommendations were developed before the US Food and Drug Administration (FDA) approved new, highly concentrated insulins.
Tirzepatide Versus Semaglutide Once Weekly In Patients With Type 2 Diabetes
The ADA suggests that patients receiving multiple daily insulin injections consider SMBG before meals and snacks, sometimes after meals, at bedtime, before exercise, when hypoglycemia is suspected and after treatment, and before critical tasks such as driving.
Reductions in A1C levels have also been shown in patients taking only basal insulin who perform a fasting blood glucose test and achieve their fasting blood glucose goal.
Doing more frequent SMBG can be helpful; One study showed that increased frequency was associated with better glycemic control.
The ADA recommends a fasting and premeal SMBG goal of 80 to 130 mg per dL (4.4 to 7.2 mmol per L) and a two-hour postprandial goal of less than 180 mg per dL (10.0 mmol per L).
Once Weekly Tirzepatide Versus Once Daily Insulin Degludec As Add On To Metformin With Or Without Sglt2 Inhibitors In Patients With Type 2 Diabetes (surpass 3): A Randomised, Open Label, Parallel Group, Phase 3 Trial
The AACE/ACE guidelines recommend a fasting and premeal SMBG goal of 70 to 110 mg per dl (3.9 to 6.1 mmol per L) and a two-hour postprandial goal of less than 140 mg per dl (7.8 mmol per L).
Patients with unstable or uncontrolled type 2 diabetes should have their A1C tested every three months. Twice-yearly measurements are reasonable for patients with stable diabetes and A1C levels that are within target.
A UK prospective diabetes study showed that patients with newly diagnosed type 2 diabetes who received intensive therapy (7% achieved mean A1C) with sulfonylureas, insulin, or metformin had a significantly increased risk of microvascular complications compared to patients who received conventional therapy (media). was way less. achieved an A1C of 7.9%).
However, most of the benefits in this study were due to a reduced need for photocoagulation treatment of diabetic retinopathy. Several recent trials of intensive therapy in elderly patients with long duration of diabetes and high risk of atherosclerotic cardiovascular disease have shown no effect on the incidence of macrovascular complications or increased incidence of hypoglycemic events and increased mortality.
Complementary Approaches To Improving Glucose Control—insulin And Incretins: Patient Case Studies In Action
The ADA recommends a target A1C of less than 7% for most non-pregnant patients with type 2 diabetes. A short-term A1C goal of less than 6.5% may be appropriate for patients with type 2 diabetes treated with lifestyle changes or metformin alone, long life expectancy, and no significant cardiovascular disease as long as there is significant hypoglycemia or other adverse effects. doesn’t happen For patients with severe history
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