Initiating Insulin in type 2 diabetes in Primary care

Question 1

when do you consider starting insulin in type 2 diabetes

Answer 1

• when you are failing to obtain their target HbA1c control with at least two oral hypoglycaemic agents

Question 2

how do you normally titrate insulin

Answer 2

• normally increase in steps of around 10% at a time once or twice a week
• if you have to decrease by decrease down by 20%

Question 3

How should you store insulin

Answer 3

• room temperature - insulin will loose its effectiveness if its too hot or too cold

Question 4

what are the sick day rules for insulin

Answer 4

• patients must not stop taking insulin even when they have intercurrent illness
• when they are unwell the patient’s blood glucose may rise even if they are not eating
• they need to test their blood glucose more regularly at least once every 4-6 hours and may need to adjust their dose of insulin
• they also need to ensure that they eat enough carbohydrate an drink enough fluid
• if the patient starts vomiting, cannot keep fluid down or is unable to control their blood glucose or ketone levels, then they should seek urgent medical advice