Dose Of Insulin In Type 2 Diabetes – Type 2 diabetes is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the main components of which are insulin resistance and progressive beta cell failure in muscle, liver, and adipocytes.

Beta cell failure progresses at a rate of approximately 4% per year, requiring the use of multiple medications, often including insulin, to achieve and maintain glycemic control.

Dose Of Insulin In Type 2 Diabetes

Data from the National Health and Nutrition Examination Survey show that the percentage of US adults with diabetes and an A1C level greater than 9% increased from 13% to 12.6% between 2003 to 2006 and 2007 to 2010 (relative risk reduction = 3.%; 95% confidence interval, – 3.8% to -3.0%).

Eadsg Guidelines: Insulin Therapy In 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.

Therefore, it is possible that many patients who should receive insulin therapy. American Family Physician recently published a review of noninsulin therapies for type 2 diabetes.

Physicians should minimize the use of concomitant medications that may cause weight gain when treating patients with insulin therapy for type 2 diabetes mellitus.

Consider initiating basal insulin to augment therapy with one or two oral agents or an oral agent and a GLP-1 receptor agonist when A1C is 9% or greater, especially if there are signs of hyperglycemia or catabolism. Or, consider adding basal insulin to augment therapy with two oral agents with or without GLP-1 receptor agonists when A1C exceeds 8%.

Type 2 Diabetes Mellitus: Outpatient Insulin Management

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 escalation therapy but not achieving A1C goals.

A1C targets should be individualized based on age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, adverse outcomes associated with hypoglycemia, or patient motivation and adherence.

Intensive control of type 2 diabetes (A1C target less than 7%) significantly reduces the need for photocoagulation treatment of diabetic retinopathy but increases the risk of hypoglycemia and mortality.

American Diabetes Association (ADA) guidelines and American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) guidelines recommend minimizing the use of concomitant medications that may cause weight gain when treating patients with type 2 diabetes.

Insulin Pump Therapy For People With Type 2 Diabetes

Based on expert opinion, long-acting (basal) insulin combined with metformin, pramlintide (Symlin), or a glucagon-like peptide 1 (GLP-1) receptor agonist may be better for weight loss than basal insulin alone in obese patients. or combined with sulfonylureas.

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 the 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, treatment requires assistance from others). 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.

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

All patients should be educated about the symptoms of hypoglycemia and self-treatment. 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 g of fast-acting carbohydrates, such as 4 oz of fruit juice or three or four glucose tablets; and (3) check again after 15 minutes to make sure the blood glucose level is normal.

Additionally, 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, end-stage chronic diseases, ‡ moderate to severe cognitive impairment, or 2 or more ADL impairments)

Insulin may be used as augmentation or replacement therapy. The ADA and AACE/ACE guidelines for initiating insulin therapy are summarized in Figure 1.

Pharmacologic Approaches To Glycemic Treatment Of Type 2 Diabetes: Synopsis Of The 2020 American Diabetes Association’s Standards Of Medical Care In Diabetes Clinical Guideline

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 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 required to cover a certain gram of carbohydrate ingested

Visualabstract: Weekly Icodec Versus Daily Glargine U100 In Type 2 Diabetes Without Previous Insulin

How much 1 unit of insulin is expected to lower the patient’s blood glucose level; When blood glucose levels are above a predetermined target, short-acting insulin can be added to a bolus dose 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 treatment with one or two oral agents or one oral agent and 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 treatment with two oral agents with or without GLP-1 receptor agonists when A1C exceeds 8%.

Integrated Algorithm Addressing Management Of Type 1 And Type 2…

The ADA also recommends basal insulin with other agents when A1C is greater than 9% at diagnosis and the patient has symptoms of hyperglycemia.

The ADA recommends 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 when A1C is greater than 10%. gives 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 receiving insulin augmentation therapy who do not meet A1C goals, the AACE/ACE guidelines recommend the addition of 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 more.

Dosing Lantus® (insulin Glargine Injection) 100 Units/ml

The long-acting insulin analogs detemir (Levemir) and glargine (Lantus) cause significantly fewer nocturnal hypoglycemic events than isophane (NPH; Humulin N) human insulin.

The rapid-acting insulin analogs aspart (Novolog), glulisine (Epidra), and lispro (Humalog) are associated with a small but statistically significant reduction in hypoglycemic events compared with regular human insulin.

The ADA recommends adjusting the insulin regimen once or twice a week (or every three or four days) until self-monitoring blood glucose (SMBG) goals are reached.

Show different approaches to insulin titration depending 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.

Using Insulin In Type 2 Diabetes

The ADA recommends that patients receiving multiple daily insulin injections consider SMBG before meals and snacks, occasionally after meals, at bedtime, before exercise, when hypoglycemia is suspected and after treatment, and before important activities such as driving.

A1C levels have also been shown to decrease in patients taking only basal insulin who test fasting blood glucose and achieve fasting blood glucose goals.

More frequent SMBG performance may 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).

Japanese Clinical Practice Guideline For Diabetes 2019

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 an A1C test every three months. Twice yearly measurements are reasonable for patients with stable diabetes and A1C levels within target.

The UK Prospective Diabetes Study showed that patients with newly diagnosed type 2 diabetes who received intensive therapy with sulfonylurea, insulin or metformin (average A1C achieved 7%) had a significantly lower risk of microvascular complications than patients who received conventional therapy. A1C achieved 7.9%).

However, most of the benefits of this study were due to a reduced need for photocoagulation treatment of diabetic retinopathy. Several recent trials of intensive therapy in elderly patients with a long duration of diabetes and high risk of atherosclerotic cardiovascular disease have shown no effect on the incidence of macrovascular complications or hypoglycemic events and on increased mortality.

Type 2 Diabetes Management Toolbox: From Lifestyle To Insulin

The ADA recommends a target A1C of less than 7% for most non-pregnant patients with type 2 diabetes. An A1C goal of less than 6.5% may be appropriate for patients with short-term type 2 diabetes treated with lifestyle changes or metformin alone, long life expectancy, and no significant cardiovascular disease, unless significant hypoglycemia or other adverse effects occur. does not arise. For patients with severe history

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