EFFECTIVE USE OF INSULIN THERAPY IN TYPE 2 DIABETES

Type 2 diabetes is a progressive disease; an individual’s ability to secrete insulin in increasing amounts to overcome insulin resistance progressively fails over time. As diabetes and beta cell failure progress, the increasing need for insulin becomes apparent. Thus, to improve metabolic outcomes and prevent complications, insulin must be used effectively and in a timely manner. The gold standard of insulin therapy today is to create physiologic insulin replacement with mealtime insulin spikes and continuous basal insulin replacement. Peak insulin concentration can vary by 39%, representing a significant intrasubject coefficient of variation. The pharmaceutical industry has attempted to develop and produce more effective insulin formulations to meet varying patient needs. Efforts have been directed at developing both basal and premeal insulin analogs. Rapid-acting insulin analogs are superior premeal insulins. Several insulins can be used for basal replacement, including neutral protamine Hagedorn (NPH), lente, ultralente, and insulin glargine. There are also several premixed insulin formulations, including lispro/neutral protamine lispro, and regular/NPH; these premixed insulins are suitable only for type 2 diabetes. They are particularly valuable for patients who may have problems with mixing accuracy and compliance.