Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-95

Premixed insulin therapy Premixed insulin therapy may be suitable for individuals with stable type 2 diabetes and a consistent schedule. Premixed insulin analogue preparations have protamine added to provide a prolonged duration of action. Premixed insulin analogues are preferred over premixed insulins, as they have improved postprandial BG levels, a reduced risk of hypoglycemia, and are more convenient in terms of timing of administration just prior to meals, rather than 30 -45 minutes before the meal, as would be recommended with premixed non-analogue insulins.

Figure 7. Premixed insulin therapy

Rapid or short (R or S) Biphasic/protamine or intermediate-acting

Morning

Afternoon

Evening

Night

R/S

R/S

Premixed insulin

Premixed insulin

Brkfst

Lunch

Dinner

Bed

Brkfst

Breakfast

Dinner

Premixed insulin

Premixed insulin

(rapid/biphasic or protamine)

(rapid/biphasic or protamine)

© Leadership Sinai Centre for Diabetes

• Insulin type and timing:

o Before breakfast and before dinner. o Premixed insulin analogues are preferred over premixed insulin.

• Dosage:

o Initiate at 5-10 units once daily or twice daily (pre-breakfast and/or pre-supper)