Street drugs

August 2010

Clinical

Type 2 diabetes

Controlling hyperglycaemia with early insulin use

Volume 39, No.8, August 2010 Pages 565-569

Richard J MacIsaac

Ada Cheung

George Jerums

Background

Many patients with type 2 diabetes need to progress to insulin use when oral glucose lowering therapies fail to maintain adequate glycaemic control.

Objective/s

To suggest when and how to initiate insulin therapy for patients with type 2 diabetes in the primary care setting.

Discussion

In general, initiation of insulin should be considered in individuals on maximal tolerated doses of metformin and sulfonylureas with HbA1c levels >7.0% over a 3–6 month period. Current Australian guidelines recommend initiating insulin therapy as once daily basal therapy or as premixed insulins.

Type 2 diabetes is characterised by insulin resistance, a progressive decline in beta-cell function, and worsening hyperglycaemia. HbA1c levels of <7.0% remain the target for good glucose control but individualisation of glycaemic targets has been advocated by the Australian Diabetes Society (Table 1).1

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Correspondence afp@racgp.org.au

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