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  • Title: [Recommendations concerning the initial regimen and dose adjustments of insulin therapy for type 2 diabetes mellitus].
    Author: Houweling ST, Timmerman GJ, Hoogstraten MF, Ubink-Veltmaat LJ, Verhoeven S, Bilo HJ.
    Journal: Ned Tijdschr Geneeskd; 2002 Sep 28; 146(39):1823-7. PubMed ID: 12382366.
    Abstract:
    Although physicians are confronted with an increasing number of insulin-treated patients with type 2 diabetes mellitus, guidelines for the initial insulin regimen and dose adjustment are rare. If the fasting blood glucose level is > 10 mmol/l and the postprandial values are not much higher than the fasting ones, then the patient can be started on 8-12 IU of an intermediate-acting insulin before going to sleep. In the case of blood glucose levels which increase during the day or if a single insulin dose has insufficient effect, the patient can be started on a twice-daily administration of a premixed insulin. If more than 40 IU of insulin per injection are needed to regulate the blood glucose levels, it might be necessary to switch to administering insulin 4 times per day. Of this total daily quantity, initially 20% is administered as (ultra)short-acting insulin before the three daily meals and 40% as a bedtime intermediate-acting insulin. Occasionally elevated blood glucose levels do not necessarily have to be a reason for adjusting the insulin dosage.
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