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

6. Insulin and Type 2 Diabetes

1. Meal plan, activity and weight loss, if overweight.
2. Meal plan and single medication or insulin.
3. Meal plan and 2 agents.

Insulin is used in type 2 diabetes when blood glucose can not be controlled by other methods. If blood glucose >126 mg/dl fasting and over 200 mg/dl postprandial after trying meal planning, activity, and weight loss, medications or insulin is indicated.

Some patients may need to be started on insulin immediately, especially if they have unexplained weight loss and severe hyperglycemia. Some of these patients may actually have type 1 diabetes.

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.