Insulin therapy in type 2 diabetes for physicians and practitioners.

ABSTRACT

Insulin after its clinical use in the early 1920s has undergone major advances to become widely accepted to combat all patients with type 1 diabetes and many of type 2 diabetes. Twenty-seven per cent patients of type 2 diabetes use insulin therapy but less than 1/2 achieves recommended HbA1c level 7 per cent or less. So suboptimal insulin therapy is common. It can be said that premix insulin can be used safely in combination with OHAs once or twice a day. Insulin analogues were created to achieve optimum glycaemic control. Storage, mixing Insulins and timing and site of injection of insulin have been narrated. Insulin regimen depends on diagnosis, glycaemic status, patient compliance and physicians' choice. Basal only insulin, once/twice daily premix insulin, basal bolus insulin regimen have also be described. A common starting dose in type 2 diabetes is 0.15 units/kg body weight/day, however higher doses are often required. The evaluation of a patient is always mandatory with increasing/ decreasing insulin requirements. Insulin therapy has undergone remarkable developments in the present age. The introduction of insulin analogues, better patient friendly delivery devices has improved compliance and acceptability among diabetics.