What is the best insulin regimen for patients with diabetes?

Originally published in Insidermedicine

The best method for taking insulin among individuals with type 2 diabetes has been identified in research published in the latest issue of the New England Journal of Medicine.

Here is some information about type 2 diabetes:

• It is a condition in which your body does not produce enough insulin and/or does not use available insulin properly

• Insulin is needed to convert sugar in the blood into energy; without it , sugar builds up in the blood

• Treatments include antidiabetic medicines that help the body produce and use insulin as well insulin replacement therapy

Researchers from the University of Oxford randomly assigned over 700 individuals with type 2 diabetes whose blood sugar levels were not adequately controlled despite taking two types of antidiabetic medicine to receive one of three insulin regimens. These regimens were basal, or long-acting insulin once daily; prandial, or short-acting insulin three times daily at mealtime; or biphasic, or short- and long-acting insulin twice daily. After one year, if blood sugar levels were not adequately controlled, one of the antidiabetic medicines would be replaced with a second type of insulin.

Most patients in all three groups eventually needed to take two types of insulin, but fewer patients in the biphasic insulin group were able to maintain adequate control of their blood sugar levels than those in either of the other two insulin groups. The risk of hypoglycemia, or dangerously low blood sugar, was highest in those taking prandial insulin, and patients taking this type of insulin also gained the most weight.

Today’s research demonstrates that individuals with type 2 diabetes who need to start taking insulin should begin with basal insulin and then add prandial insulin, as needed.

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