Insulin Intensification in Type 2 Diabetes-Insulin Intensification in Type 2 Diabetes Infographic

Insulin Intensification in Type 2 Diabetes Infographic

Pdf Summary

The document provides a concise visual guide to insulin intensification for managing Type 2 Diabetes, based on the American Diabetes Association's 2024 Standards of Medical Care. It emphasizes titrating basal insulin to a patient-specific target and highlights the importance of combating therapeutic inertia.<br /><br />The guide suggests starting with basal insulin, such as self-titrated basal analogs or nighttime Neutral Protamine Hagedorn (NPH) insulin. It recommends setting target fasting blood glucose levels, providing titration parameters (e.g., adjusting by ±2 units every 3 days if above or below target), and monitoring for hypoglycemia to make necessary insulin adjustments.<br /><br />If a patient's A1C level remains above target despite initial treatment, intensification of therapy is advised. This can include adding a GLP-1 receptor agonist (if not already used) or initiating a stepwise prandial insulin regimen. Options include basal-bolus regimens, self-mixed, pre-mixed, or twice-daily mixed insulin (BID).<br /><br />For prandial insulin initiation, recommendations include dosing with the largest meal (4 units or 10% of basal, reducing basal by 4 units if A1C is above 8%). Prandial insulin can be titrated by increasing 1-2 units or 10-15% twice weekly, while reducing the dose by 10-20% if hypoglycemia occurs.<br /><br />For patients on nighttime NPH insulin whose A1C levels remain above target, a switch to BID NPH can be initiated. The dose should be calculated at 80% of the current dose, split into two-thirds in the morning and one-third at bedtime, with further titration based on individual needs.<br /><br />The infographic warns against overbasalization and highlights signs such as low variability in AM/HS glucose readings and increased hypoglycemia risk. Healthcare providers are reminded to use clinical judgment and visit therapeuticinertia.diabetes.org for more information.

Keywords

insulin intensification

Type 2 Diabetes

American Diabetes Association

basal insulin

therapeutic inertia

GLP-1 receptor agonist

prandial insulin

hypoglycemia

NPH insulin

overbasalization