NPH at HS -duration of action too short: usually need AM injection -nighttime hypoglycemia a problem
Analogs –likely to succeed as true once daily injection -detemir advantages: pen use & 32g needle less weight gain?
Summary
The addition of new long-acting insulin analogs to the rapid-acting analogs now allows for proper institution of the basal-bolus paradigm of insulin administration
Greater lifestyle flexibility with less hypoglycemia will result
Type 2s failing oral agents can now realistically hope to achieve glycemic targets with a single insulin injection
Case 1
48 yo male, 5’10” 225lbs, DM2 x 10yrs, A1c 8.7% on met 1000 bid, glyb 10 bid, avandia 4 bid
Next step?
Case 2
60 yo female 5’2” 170lbs, DM2 x 12yrs, A1c 8.4% on met 1000 bid, glyb 10 bid, N 26 qHS (started 6 months ago), fasting bs 6-8, denies lows
Next step?
Case 3
68 yo male, DM2 x 20yrs, insulin x 10yrs, A1c 8.4% on 30/70 50qAM, 40qPM, rare lows
Next step?
Case 3b
Same pt, now on 30/70 40qAM, 30qPM, met 1000bid, A1c 7.4%, frequent lows
Next step?
Case 4
38 yo female DM1 x 30yrs, A1c 7.9% on am N22R14, pm N16R10, frequent lows, needed ambulance last week
Next step?
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