Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS

Chapter 6
Insulin and Other Drugs Used in the Treatment of Type 2 Diabetes

Insulin

Insulin is used in type 2 diabetes when blood glucose (BG) levels exceed 126 mg/dl fasting or exceed 200 mg/dl postprandial after trying meal planning, activity, and weight loss.

Some may need to be started on insulin immediately, especially if they have unexplained weight loss and severe hyperglycemia.

Hyperinsulinemia

The theoretical disadvantage of hyperinsulinemia from using insulin injections does not outweigh the proven benefits of glycemic control.

Starting insulin

• Lean patients: 15 units NPH or Lente per day
  Obese patients: 20-30 units of NPH or Lente per day 

Doses can be increased 2-5 units every 3-4 days, depending on blood glucose levels. Some may need over 100 units of insulin per day to control blood glucose.

Adjunct Therapies for Type 2 Diabetes

Exanatide (Byetta)
was released for use in 2005 and is used in addition to insulin and/or analogs to assist in gaining better control of blood glucose levels. Pramlintide acetate (Symlin®) is a synthetic analog of human amylin. Amylin is a hormone also made and secreted by the beta cells, and therefore lacking in persons with type 1 diabetes. In those without diabetes, it is secreted along with insulin to control post-prandial blood glucose levels. Its anti-hyperglycemic effects include:

• Slowing gastric emptying
• Suppressing glucagon release, resulting in less glucose release from the liver.
• Regulation of food intake due to modulation of appetite.

Pramlintide acetate is administered by subcutaneous injection prior to meals to mimic normal levels. Injection technique is the same as that for insulin. It cannot be mixed with insulin and may require pre-meal insulin be reduced to prevent hypoglycemia. Side effects may include nausea, vomiting, dizziness, indigestion, stomach pain, decreased appetite and fatigue. Its use is contraindicated in those with gastroparesis, hypoglycemia unawareness, women who are pregnant or breastfeeding and children.

Vials in use can be stored at room temperature (less than 77°F) for 28 days and then discarded. Vials not in use should be stored in the refrigerator and discarded after the expiration date.