Initiating Insulin Therapy in Type 2 Diabetes: Benefits of Insulin Analogs and Insulin Pens

2008 ◽  
Vol 10 (4) ◽  
pp. 247-256 ◽  
Author(s):  
Stephen Brunton
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Insulin Analogs ◽  
Insulin Pens

Insulin Devices

2008 ◽  
Vol 34 (6) ◽  
pp. 957-967 ◽  
Author(s):  
Geralyn Spollett
Keyword(s):  
Type 2 Diabetes ◽  
Elderly Patients ◽  
Insulin Therapy ◽  
Manual Dexterity ◽  
Individual Needs ◽  
Insulin Pens ◽  
The Ideal

Purpose The purpose of this article was to identify and address barriers to initiating insulin therapy in patients with type 2 diabetes. Results Insulin pen devices address many of the mechanical barriers associated with a syringe and vial. In addition, pen devices are increasingly being improved, offering long-term pen users benefits over earlier pen users. These devices can be tailored to address the specific needs of different patient populations, such as elderly patients or those with visual or manual dexterity disabilities. Although insulin devices offer benefits over the syringe and vial, features desirable in the ideal pen have not been established. Conclusions Data suggest that currently available insulin pens possess various features that make them suitable for particular patients. Individual needs of each patient should be considered before an insulin pen device is prescribed.

On pens and needles: Treatment strategies for psychological insulin resistance in type 2 diabetes mellitus

2013 ◽  
Vol 3 (5) ◽  
pp. 266-270 ◽  
Author(s):  
Erika Tillery ◽  
Marquita Bradshaw ◽  
Ijang Ngando
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Insulin Therapy ◽  
Clinical Outcomes ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Insulin Pens

Background: Psychological insulin resistance (PIR) refers to psychological opposition towards insulin therapy. Although not a formal psychological diagnosis, PIR is an under-recognized issue clinicians may encounter when treating patients with diabetes requiring insulin therapy. Methods: Review articles, clinical trials, and practice guidelines were located using online databases. A total of 39 abstracts were reviewed and 11 articles were included in the analysis. Results: Eleven articles were included. Proposed strategies used to mitigate the occurrence of PIR include: identifying the patient's personal obstacles via administration of PIR questionnaires, use of insulin pens as opposed to conventional syringe and needle, education on the risk of hypoglycemia and continuous emphasis of the importance of self-monitoring of blood glucose (SMBG) readings. Discussion: The management of type 2 diabetes mellitus (T2DM) in patients requiring insulin may present challenges such as PIR. Tailoring a patient's treatment plan to account for physiological, psychological, social and financial needs may thwart some of these challenges. Other factors to consider include the cost of the agent and/or devices required. Insulin-dependent patients with T2DM should be assessed for both physiological and psychological changes. Conclusion: Current treatment strategies for clinicians treating T2DM patients with PIR include administering the PIR or BIT questionnaire, initiating lower doses of insulin, switching from insulin vials to insulin pens, including assessment results in individualized treatment plans and using clinical outcomes to screen patients who are at risk for refusing the use of insulin. Further research evaluating clinical outcomes associated with treatment strategies is necessary.

scholarly journals The Business of Intensive Insulin Therapy for Type 2 Diabetes Patients: Where It all Began for Me

2009 ◽  
Vol 3 (6) ◽  
pp. 1521-1523 ◽  
Author(s):  
Evan Norton
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Trial Data ◽  
Nutrition Examination Survey ◽  
Significant Issue ◽  
Health And Nutrition ◽  
Improve Compliance ◽  
Insulin Pens

Ideally, it would be easy for physicians with Diabetes Control and Complications Trial data in hand to convince type 2 diabetes mellitus (T2DM) patients on insulin to move toward intensive insulin therapy (IIT), but in actuality, patient compliance remains a significant issue. One of the statistics that best illustrates this point is that 89% of T2DM patients on insulin do not inject themselves outside of the home (according to the National Health and Nutrition Examination Survey). The market has responded to poor compliance by developing insulin pens and different insulin formulations to improve compliance. But the fact remains that most T2DM patients on insulin are out of control. I would suggest that, in addition to better education, an opportunity exists for a medical device approach to better facilitate an easy-to-use, discreet approach to moving from conventional to IIT.

scholarly journals Initiating Insulin Therapy in Type 2 Diabetes: A comparison of biphasic and basal insulin analogs

Diabetes Care ◽  
2005 ◽  
Vol 28 (2) ◽  
pp. 260-265 ◽  
Author(s):  
P. Raskin ◽  
E. Allen ◽  
P. Hollander ◽  
A. Lewin ◽  
R. A. Gabbay ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Analogs

scholarly journals Non-glycemic effects of insulin therapy: a comparison between insulin aspart and regular human insulin during two consecutive meals in patients with type 2 diabetes

2011 ◽  
Vol 165 (2) ◽  
pp. 269-274 ◽  
Author(s):  
H Sourij ◽  
I Schmoelzer ◽  
A de Campo ◽  
N J Tripolt ◽  
T Stojakovic ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Human Insulin ◽  
Insulin Aspart ◽  
Postprandial Hyperglycemia ◽  
Regular Human Insulin ◽  
Insulin Analogs ◽  
C Peptide ◽  
The Mean

ObjectiveTo control postprandial hyperglycemia in insulin-treated type 2 diabetic patients, prandial therapy with regular human insulin (HI) or fast acting insulin analogs is used. Postprandial hyperglycemia seems to be reduced more effectively with insulin analogs than with normal insulin, but there are no data concerning the effect on lipolysis or pancreatic insulin and proinsulin secretion of normal insulin in comparison to insulin analogs.Design and methodsWe included 13 patients with type 2 diabetes mellitus (age 62.2±10.3 years) with preexisting insulin therapy in this crossover, prospective, open-labeled, randomized trial comparing regular HI with insulin aspart (IA) in the setting of a standardized breakfast and a standardized lunch 4 h later. Blood samples for determination of glucose, free fatty acids (FFA), triglycerides, C-peptide, and intact proinsulin were drawn during fasting and every 30 min until 4 h after the second test meal. Statistical analysis was performed with ANOVA for repeated measurements and paired Student's t-test.ResultsThe mean increase in blood glucose was significantly lower after IA (24.18±16.33 vs 34.92±29.07 mg/dl, P=0.02) compared with HI. Both therapies reduced FFA; however, the mean reduction was significantly higher after IA than after HI (−0.47±0.16 vs −0.35±0.15 μmol/l, P<0.001). The mean increase in intact proinsulin was significantly lower after IA than after HI (10.53±5 vs 15.20±6.83 pmol/l, P<0.001). No differences were observed in the C-peptide levels between the two groups.ConclusionIn the setting of two consecutive meals, IA reduces lipolysis and proinsulin secretion more effectively than HI.

Insulin Therapy in Type 2 Diabetes

2013 ◽  
Vol 09 (01) ◽  
pp. 6 ◽  
Author(s):  
Etie Moghissi ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Limiting Factor ◽  
Insulin Analogs ◽  
Duration Of Action ◽  
Timely Initiation ◽  
Long Acting

Due to the progressive nature of Type 2 diabetes, insulin therapy is often required to achieve glycemic control. When lifestyle modifications and treatment with metformin with or without other oral antidiabetic drugs (OADs) have failed to achieve normoglycemia, timely initiation of singledose basal insulin treatment is a convenient, effective, and recommended strategy. The development of the long-acting basal insulin analogs, insulin detemir (IDet) and insulin glargine (IGlar), has resulted in significant improvements in the management of Type 2 diabetes, and specifically, in reducing rates of hypoglycemia. However, hypoglycemia still remains a limiting factor in the intensification of insulin therapy. Combination regimens involving insulin and incretin-based therapies have resulted in improved glycemic control with a similar rate of hypoglycemia compared with insulin alone. Novel basal insulin analogs may also help address the unmet needs associated with basal insulin therapy. Insulin degludec (IDeg) is a basal insulin analog that offers an ultra-long duration of action of more than 42 hours in adults, more flexibility compared with other long-acting insulin analogs in terms of daily dosing times, and reduced rates of hypoglycemia. Pegylated (PEG) lispro, an agent that is currently in clinical development, also offers an extended duration of action. The potential for fewer hypoglycemic episodes offered by combined regimens and new agents may improve adherence to insulin regimens.

Should insulin therapy be started earlier in type 2 diabetes?

2008 ◽  
Vol 41 (10) ◽  
pp. 8
Author(s):  
MARTIN J. ABRAHAMSON ◽  
BARRY J. GOLDSTEIN
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy
Sign in / Sign up

Export Citation Format

Share Document