Building a solid foundation in diabetes: the nuts and bolts of insulin therapy

Insulin therapy is required for survival by all individuals with type 1 diabetes mellitus. It is also used to improve glycemic control in some individuals with longstanding type 2 diabetes mellitus who are not profoundly insulin deficient, and may be preferred over other antidiabetic medications for this purpose. As the number of patients with diabetes continues to grow, family physicians will correspondingly care for an increasing number of patients who use insulin therapy. Family physicians need to acquire the essential skills to safely and effectively initiate and titrate common insulin regimens. Several methods to initiate and titrate basal, basal-bolus, and premixed/biphasic insulin therapy, especially in individuals with type 2 diabetes mellitus, are described in this activity. Furthermore, insulin analogues permit more physiologic insulin delivery than recombinant human insulins, but new insulin formulations are currently being developed that have the potential to further reduce glycemic variability and the risk of hypoglycemia. Emerging data on investigational insulins will be reviewed. This webcast is available through the website of The American Journal of Medicine (www.amjmed.com). Click on the “Building a Solid Foundation in Diabetes: The Nuts and Bolts of Insulin Therapy” link in the “CME Multimedia Activities” section, found on the right side of the Journal homepage.