Possible Strategy for Insulin Administration

New research indicates a mixture of fast-acting and intermediate-acting insulin (biphasic) may be more effective at lowering blood sugar levels than other traditional insulin strategies.

In cases of type 2 diabetes, insulin therapy usually comes after many other therapies have failed to control a person’s diabetes. When a person is diagnosed with diabetes doctors will often start improving diet, increasing exercise and activity, and prescribing metformin. If this strategy doesn’t bring an individual’s hemoglobin A1C score below 6.5 percent, doctors will often add a sulfonylurea pill.

After a few months, if the patient still hasn’t reached the 6.5 percent A1C goal, it is usually time to start insulin. But, with so many types of insulin and so many ways to time doses, it is hard to know what insulin strategy is best. A group of British physicians and scientists published an article in the New England Journal of Medicine that suggests an optimal insulin strategy.

Pescribing a single analogue-insulin formulation with medications reduced hemoglobin levels to 6.5 percent or less in only a small percentage of patients. Researchers tried adding either biphasic or prandial (meal time) insulin aspart. This extra treatment lowered blood sugar to the acceptable level in a significant number of patients. However, the second dose of insulin was associated with greater risks of hypoglycemia and weight gain.

Many patients and doctors may decide to pursue a different strategy because of individual circumstances. If you think adding biphasic or prandial insulin to your treatment strategy will help, talk to your doctor.