How can earlier initiation of insulin help
my patients with type 2 diabetes?
How can I help my patients succeed in controlling
their blood glucose?
How can earlier initiation of insulin help my patients with type 2 diabetes?
Patients with type 2 diabetes suffer from insulin deficiency long before diagnosis.11
By the time most patients are diagnosed with type 2 diabetes, their pancreatic beta-cell
function may have already deteriorated up to 50%.11 Many times, patients aren’t started on insulin until
their A1C reaches an average of 9.3%. In one study, it was shown that from the time
of diagnosis to the start of insulin therapy, the average patient spent nearly 5
years with an A1C >8% and about 10 years with A1C >7%.a 11 Adding insulin to oral diabetes treatment for your appropriate patients
with diabetes could significantly lower A1C levels.1,2
a Based on retrospective observational data from 7208 episodes of treatment initiation and secondary failure.
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How can I help my patients succeed in controlling their blood glucose?
Patient compliance is an important part of insulin therapy. More than one-quarter
of patients with type 2 diabetes reported that they would be unwilling to take insulin
therapy if prescribed.46
It is important to keep an open dialogue with patients to help address their concerns.
Several psychological barriers to the initiation of insulin therapy have been identified:
injection anxiety, fear of hypoglycemia, or personal failure.13,47,48
One way to transition patients to insulin therapy is with a Certified Diabetes Educator,
or CDE. CDEs can teach patients the basics of diabetes self-management to support
informed decision-making.
Patients should be informed that changes to insulin regimens must be made cautiously
and only under medical supervision. It is important to inform patients about the
potential side effects of insulin therapy, including hypoglycemia, lipodystrophy
(and the need to rotate injection sites within the same body region), weight gain,
and allergic reactions.
It is critical to instruct patients on self-management procedures, including glucose
monitoring, proper injection technique, and management of hypoglycemia and hyperglycemia.
Patients must be instructed on handling of special situations such as intercurrent
conditions (illness, stress, or emotional disturbances), an inadequate or skipped
insulin dose, inadvertent administration of an increased insulin dose, inadequate
food intake, and skipped meals.
Another way to help patients initiate insulin is to address the method of insulin
administration. Explain all options available for insulin delivery, including easy-to-use
pens.42
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Useful tools for your LANTUS® patients >
CONTRAINDICATIONS
Lantus® is contraindicated in patients hypersensitive to insulin glargine or
one of its excipients.
WARNINGS AND PRECAUTIONS
Monitor blood glucose in all patients treated with insulin. Insulin regimens should
be modified cautiously and only under medical supervision. Changes in insulin strength,
manufacturer, type, or method of administration may result in the need for a change
in insulin dose or an adjustment in concomitant oral antidiabetic treatment.
Do not dilute or mix Lantus® with any other insulin or solution. If mixed or
diluted, the solution may become cloudy, and the onset of action/time to peak effect
may be altered in an unpredictable manner. Do not administer Lantus® via an
insulin pump or intravenously because severe hypoglycemia can occur. Insulin devices
and needles must not be shared between patients.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®,
and may be life-threatening.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
A reduction in the Lantus® dose may be required in patients with renal or hepatic
impairment.
DRUG INTERACTIONS
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and
close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients
taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and
reserpine).
ADVERSE REACTIONS
Other adverse reactions commonly associated with Lantus® are injection site
reaction, lipodystrophy, pruritus, and rash.
Lantus® SoloSTAR® is a disposable prefilled insulin pen. To help ensure
an accurate dose each time, patients should follow all steps in the Instruction
Leaflet accompanying the pen; otherwise they may not get the correct amount of insulin,
which may affect their blood glucose.
Lantus® is a long-acting insulin analog indicated to improve glycemic control
in adults and children (6 years and older) with type 1 diabetes mellitus and in
adults with type 2 diabetes mellitus. Lantus® should be administered once a
day at the same time every day.
Important Limitations of Use: Lantus® is not recommended for the treatment of
diabetic ketoacidosis. Use intravenous short-acting insulin instead.
Lantus® SoloSTAR® is a disposable prefilled insulin pen.
Please click here for full prescribing information.
CONTRAINDICATIONS
Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive
to Apidra® or any of its excipients.
WARNINGS AND PRECAUTIONS
Closely monitor blood glucose in all patients treated with insulin. Change insulin
regimens cautiously and only under medical supervision. Changes in insulin strength,
manufacturer, type, or method of administration may result in the need for a change
in insulin dose or an adjustment in concomitant oral antidiabetic treatment. As
with all insulin preparations, the time course of Apidra® action may vary by
individual or at different times in the same individual and is dependent on many
conditions, including the site of injection, local blood supply, or local temperature.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Apidra®,
which may be serious.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur.
All insulins, including Apidra®, can cause hypokalemia, which if untreated,
may be serious.
A reduction in the Apidra® dose may be required in patients with renal or hepatic
impairment.
Apidra® for subcutaneous injection should not be mixed with insulins other than
NPH. Do not mix Apidra® with any insulin when used in the pump or for intravenous
administration. Insulin devices and needles must not be shared between patients.
DRUG INTERACTIONS
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and
close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients
taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and
reserpine).
ADVERSE REACTIONS
Other adverse reactions commonly associated with Apidra® include injection site
reactions, lipodystrophy, pruritus, and rash.
Apidra® is a rapid-acting insulin analog indicated to improve glycemic control
in adults with type 2 diabetes or adults and children (4 years and older) with type
1 diabetes.
When used as a mealtime insulin, the dose of Apidra® should be given within 15 minutes
before or within 20 minutes after starting a meal. Apidra® given by subcutaneous injection
should normally be used in regimens that include a longer-acting insulin.
Please click here for full prescribing information for Apidra®
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