Using prandial insulin to achieve glycemic control in type 2 diabetes

Once you have this 24-hour insulin dose, you’ll then need to calculate the dose of basal insulin, which is 50% of the 24-hour total insulin dose, administered once daily. The remaining 50% of the total 24-hour dose provides prandial insulin coverage and is usually administered as follows:

• 30% to 40% at breakfast
• 30% at lunch
• 30% to 40% at dinner

Patients will need to adjust prandial insulin doses based on self-monitored blood glucose values.

Premixed insulin formulations

You should have your patients administer basal-prandial insulin as separate injections (eg, insulin glargine and insulin glulisine,³⁰ or insulin detemir and insulin aspart²⁵ ). The premixed (NPH based) formulations provide fixed doses of an intermediate-or long-acting insulin combined with a short-acting insulin. Although this method may be convenient to administer, it is more rigid and may not account for mealtimes and exercise. As a result, insulin levels will not match physiological insulin and thus, the risk for hypoglycemia increases. Another disadvantage is that adjustments to the dose based on self-monitored glucose levels are not possible with pre-mixed formulations.⁴¹

Separating the basal and prandial insulin components allows the insulin regimen to be adapted to an individual’s needs, thereby providing glycemic control with less propensity for hypoglycemia.

Acknowledgments

This article was supported by Sanofi-Aventis US. While the author is responsible for all content, he gratefully acknowledges the embryon scientific staff, who assisted in the preparation of a first draft of this article based on an author-approved outline, and also assisted in implementing author revisions.

Correspondence
George E. Dailey, MD, Senior Consultant, Division of Diabetes and Endocrinology, Head, Diabetes Research, Scripps Clinic, 10666 N. Torrey Pines Road, La Jolla, CA 92037; dailey.george@scrippshealth.org