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Case studies

Insulin use in patients with type 2 diabetes: problem solving

Pat Phillips
Abstract
In people with type 2 diabetes treated with insulin, problems can arise due to the injection technique used and an incomplete understanding of the principles of insulin adjustment. Ongoing patient review and education is essential.
Key Points
  • Insulin should be injected subcutaneously and the needle/injector should not move after insertion.
  • Insulin injection technique, including site, should be reviewed as part of the annual cycle of care of a person using insulin.
  • Premix, self-mix and basal–bolus schedules offer increasing levels of flexibility, effectiveness, complexity and imposition.
  • A premixed schedule may suit people with a regular daily routine, whereas those with a more variable routine or wanting tighter glycaemic control may prefer a self-mix or basal–bolus schedule.
  • Differences in endogenous insulin secretion explain why people with type 1 or long-standing type 2 diabetes are more likely to have wide swings in blood glucose levels than those with shorter duration type 2 diabetes.
  • Any corrective bolus insulin doses should be small, blood glucose levels should be checked two to four hours later and further small bolus doses given if necessary.

    Picture credit: © Caiaimage/Chris Ryan/Diomedia.com

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