The main objective in patients with diabetes is to keep blood glucose within normal limits and in the most physiological way possible, with the lowest risk of hypoglycemia. O insulin has been shown to be the most potent and effective drug in the diabetes management. the appearance of long-acting insulin given every 24 hours becomes a fundamental tool for patients with type 2 diabetes not controlled with oral treatment.

the role of insulin It is not just the glycadate adjustment in cases where oral options have not been exhausted, but also at the beginning of treatment where there is insulinopenia or insulin resistance so high that cardinal symptoms of diabetes have arisen.

When starting the insulin therapy both the patient and their caregiver must be educated to do it correctly: dose adjustments, device, administration technique, as well as nutrition basics. They need to know how to act when faced with a hypoglycemia.

In this context, it is worth emphasizing the importance of new technologies applied to diabetes, which seek to increase the control, quality of life and safety of these patients. These elements include the use of a continuous glucose monitor and the implementation of multimedia systems with alarm systems interconnected with the referring physician or educator.

patient profile

patients with Type 2 diabetes probability of starting the regimen with insulin They are those who, maintaining the treatment with metformin and evaluating the control with two or three drugs in a personalized way, do not reach the glycated target. To this group can be added diabetic patients with kidney disease and filters <30% where certain drugs, such as metformin and some iDPP4, are contraindicated.

Older adults not controlled with metformin plus an iDPP4 and highly symptomatic patients with >10% glycated activity should also be considered.

combined regimen

The combined use of arGLP1, ISGLT2 or iDPP4 with basal insulin compared to the use of multiple doses of postprandial insulin has the advantage of associating weight loss and lower risks of hypoglycemia. At the beginning, more frequent checks should be carried out and, if necessary, the dose of insulin.

It should be taken into account that, in general terms, patients assume that the beginning of insulinization It is due to an advanced stage of your diabetes, due to poor control, due to a diet or excess weight that you have not managed well and for which you blame yourself.

To start

O insulinization It should be initiated when lifestyle modifications plus non-insulin antidiabetics do not achieve the goal of glycemic control. It may also be considered early in the disease, if unexplained weight loss from another cause appears, severe ketonuria, or cardinal symptoms of diabetes. In such cases, severe insulin deficiency should be suspected, particularly with glycosylated hemoglobin (HbA1c) > 9%.

During follow-up, it may be necessary to insulinization transitional in the face of certain circumstances or intercurrent episodes, such as the onset of fever, severe trauma, treatment with corticosteroids, major surgery, pregnancy, hospitalizations…, or the permanent insulinizationwhen non-insulin medications do not achieve adequate glycemic control for the patient’s individual characteristics.

For the elaboration of this article, we had the collaboration of the doctors specialists in Primary Care Marta Llaudes Soler, María del Mar Pérez Beixer, Daniel Emil Bandila Bandila, Isabel Herrero Giménez and the endocrinologist Francisco José Rodríguez Selles, from Alicante, and the general practitioners Alfonso Domenech Irles , Fernando Navarro Ros and family doctor Marina Botella from Valencia.