Insulin for type 2 diabetes: How and when to get started
With guidelines now calling for initiation of basal insulin for patients who are not at goal a year after diagnosis, familiarity with optimal timing, dosing, and titration is critical for family physicians.
Syringe and needle size. If you are ordering insulin vials, you will also need to specify the correct syringe—available in 0.3 mL (which holds 30 units), 0.5 mL (50 units), and 1 mL (100 units) sizes. If the patient requires <50 units, order a small syringe to ensure that the unit markings are clear; a 1 mL syringe is preferable for those using a larger volume of insulin. Order the smallest syringe, which also has half-unit markings, if the patient is a child.
All needles are fine, with a 29 to 31 gauge, and available in regular (12.7 mm), short (8 mm), mini (5 mm), and nano (4 mm). Recent studies have shown that absorption, safety, and adverse events are similar for all needle lengths across a variety of patient factors,21 but patients generally prefer shorter needles.
Remember, too, to specify the maximum daily dose of insulin—a consideration that will be more important when prescribing mealtime insulin but is worth mentioning here.
Finally, tell patients who are getting started on insulin about www.accurateinsulin.org. Hosted by The Endocrine Society in partnership with the American Association of Diabetes Educators, ADA, American Pharmacists Association, and American College of Osteopathic Family Physicians, among other clinical groups, the Web site is designed to help patients (as well as providers) navigate the initiation and adjustment of insulin.18
CORRESPONDENCE
Jay Shubrook, DO, FAAFP, FACOFP, The Diabetes Institute at Ohio University, Athens, OH 45701; shubrook@ohio.edu
