How is insulin therapy initiated in patients already on oral medication?

Updated: Oct 04, 2017
  • Author: Mini A Mathew, DO, PharmD; Chief Editor: George T Griffing, MD  more...
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When insulin therapy is initiated in a patient who is already on oral medication, a basal (long- or intermediate-acting) rather than short-acting or premeal insulin should be chosen. Basal insulin helps improve nocturnal and fasting blood sugar, while premeal bolus insulin decreases postprandial glucose elevations. When choosing a basal insulin and drug cost is not a barrier, insulin glargine or detemir may be a better option than NPH insulin because they do not have a peak and therefore have a lower risk of nocturnal hypoglycemia.

In all patients with type 1 diabetes and in patients with type 2 diabetes with elevated levels of postprandial blood sugars, a bolus premeal insulin should be given. All patients with type 1 diabetes and patients on oral medications may be started on basal insulin. For basal insulin, either the intermediate-acting or the long-acting insulins are used, and, for bolus or preprandial insulin, the short-acting insulins are used.

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