The typically long delay in starting insulin for patients with type 2 diabetes mellitus
may be due in part to uncertainty about how best to make the transition from oral
therapy to insulin. Recent studies show that when appropriate glycemic targets are
sought, with systematic titration of insulin dosage, several methods of beginning
insulin may be successful. Notably, either starting with a single injection of basal
insulin or starting with 3 injections of short-acting insulin at mealtimes can be
effective. Studies also suggest that continuing oral therapies and using insulin analogues
rather than human insulins may improve the effectiveness of insulin treatment relative
to the rate of hypoglycemia and gain of weight typically seen in this setting. Starting
with a single injection of insulin to control basal glycemia while continuing oral
therapy is the simplest approach, and lends itself to stepwise addition of mealtime
injections as needed to bring most patients to glycemic targets in a logical and practical
way. Future studies should consider not only the ability of regimens to reach hemoglobin
A1c targets but also the burden of adverse effects accompanying this effort with a given
method.
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© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
