Practical considerations when initiating insulin

The UK Prospective Diabetes Survey (UKPDS) demonstrated that type 2 diabetes is characterised by declining beta cell function. Achieving optimum glycaemic control becomes increasingly difficult over time and insulin continues to be the one glucose-lowering therapy that can maintain glycaemic control despite this progression.¹

The aim of insulin and drug treatment for diabetes is to achieve optimum glycaemic control without frequent or severe hyperglycaemia or hypoglycaemia.

Since initiation of insulin in type 1 diabetes is essential, this article will focus on initiation of insulin in people with type 2 diabetes.

It is well documented that good glycaemic control reduces complications associated with diabetes; good glycaemic control is considered as having an HbA₁c (glycated haemoglobin) level below 48mmol/mol², with intensification of treatment recommended if HbA₁c levels are above 58mmol/mol. However, this target should be individualised depending on the patient’s characteristics (Table 1).