Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-88

Important considerations when selecting an insulin regimen When choosing an insulin regimen, be sure to select one that is appropriate to the individual’s general health, treatment goals, self-management skills, lifestyle, socioeconomic situation, and level of engagement. It is also important to select a regimen that will minimize the risk and frequency of hypoglycemia and avoid severe hypoglycemia. An open discussion of the benefits and limitations of the different insulin regimens can help the individual with diabetes make an informed choice of which regimen would best meet their needs and thereby promote optimal self-management. Basal Insulin as an add-on to current antihyperglycemic agents (71,135,205) Basal insulin can be added to the individual’s current non-insulin antihyperglycemic agents to achieve glycemic targets. • Insulin type: Long-acting or ultra-long-acting basal insulin analogue (preferred) or intermediate acting insulin. • Timing : Antihyperglycemic agents during the day, and basal insulin is usually taken in evening (10:00 pm to 11:00 pm) or at a regular time to ensure consistency in insulin action. o Insulin detemir may require twice-daily dosing. • Dosage : o Initiate at a dose of 10 units once daily in evening (22:00-23:00) OR 0.1 to 0.2 units/kg of body weight (usually 0.2 units/kg). • Benefits : o Simple regimen: Only one injection and one FBG check. o Basal insulin: Targets hepatic glucose production (FBG/betweenmeals BG). o Antihyperglycemic agents: generally target daytime control; some noninsulin AHAs have some FBG lowering effect o Less weight gain/lower risk of hypoglycemia associated with oral agents and basal insulin versus insulin alone. o Individuals can be instructed to titrate dose by 1 unit per day (or 10%, 2-4 units once or twice weekly) until FBG targets achieved (4.0-7.0mmol/L or 4.0-5.5 mmol/L if A1C target < 7.0% not achieved). o Degludec should be titrated by 2 units every three to four days or by 4 units each week.