Insulin therapy in type 2
Diabetes In Type 2 diabetes blood sugar levels rise abnormally high.
When the amount
of glucose in the blood increases, e.g., after a meal, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates muscle and fat cells to remove glucose from the blood and stimulates the liver to metabolize glucose, causing the blood sugar level to decrease to normal levels.
In people with
diabetes, blood sugar levels remain high. This may be because insulin is not being produced at all, is not made at sufficient levels, or is not as effective as it should be.
The healthcare priorities in the treatment of type 2 diabetes are determining optimal management strategies so as to mimic the normal physiologic pattern of insulin
secretion.
The targets for glucose control are:
Oral antidiabetic therapy:
This comprises of sulfonylurea, metformin, a thiazolidinedione, glucosidase inhibitor, or a non-sulfonylurea secretagogue.
Combination Therapy with Insulin
In many patients with type 2 diabetes, insulin is first used in combination with oral therapy. The insulin treatment regimens used are neutral protamine Hagedorn (NPH) insulin and ultralente insulin administered at bedtime or twice daily, or a long-acting human insulin analog administered once daily
Basal-Bolus Insulin Therapy
Ideal insulin regimens in patients with type 2 diabetes approximate the normal physiologic pattern of insulin secretion. The function of basal insulin in these regimens is to sustain plasma glucose control for approximately 24 hours.
A wide range of insulin preparations are used to control glucose, which include short acting insulin like lispro and aspart, intermediate insulin like lente and NPH, and long acting insulin like ultralente are used to mimic physiologic basal insulin secretion. Proper use of these insulin therapies has to be assessed by the physician and prescribed accordingly.