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Because in these patients basal hyperglycemia is preponderant over prandial hyperglycemia, insulin regimens based on basal insulin should be preferred to prandial insulin at initiation of the insulin therapy.
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Iozzo, P. et al. Independent influence of age on basal insulin secretion in nondiabetic humans.
To evaluate the efficacy and long-term safety of linagliptin added to basal insulins in type 2 diabetes inadequately controlled on basal insulin with or without oral agents.
All participants received insulin by injections using the basal-bolus method or by insulin pump; those who were not using insulin, were on basal insulin only, or were on fixed-dose regimens were excluded.
Although there is much evidence available on the initiation of basal analog insulins, very few studies have investigated the effects of switching from one basal insulin to another.
Despite guideline recommendations, sliding scale insulin remains commonplace in the LTC setting and data on basal insulin use are lacking.
There was no evidence of a secondary effect of sulphonylureas on basal insulin sensitivity.
The STEP-Wise study in 296 patients poorly controlled on basal insulin and OADs also utilized self-titration for insulin detemir and add-on insulin aspart (46).
Similar mean HbA1c and daily insulin doses were observed for the groups initially receiving basal or prandial insulin, although those initiated on basal insulin experienced less weight gain and fewer hypoglycaemic events 17.
The study was designed to compare two treatment strategies: the first strategy was based on use of basal insulin, while the second strategy aimed to achieve the lowest possible postprandial glucose by use of prandial insulins.
Second, it provides two standardized recommendations based on a basal-bolus insulin titration protocol for (1) the total daily insulin dose, which is prescribed by the treating physician during the ward round, and (2) insulin dose suggestions for individual insulin administrations before each meal, at bedtime, and after intermediate BG measurements, if required.
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