[When and why start insulin in type 2 diabetes?]

Insulin initiation is a major step in medical management and life of patients with type 2 diabetes. Insulin is necessary if combination of 2 or 3 oral antidiabetic agents fail to achieve target glycemic goals, especially if HbA1c are superior to 1% from target or weight loss. Insulin will be started with bedtime intermediate-acting insulin. Insulin can be initiated with 10 units or 0.2 units/kg then increase by 2 units every 3 days until fasting levels are consistantly in targets range. If hypoglycemia occurs, insulin dose will be reduced by 4 units. Insulin initiation requires specific educational program for the acceptation of injection and to learn insulin injection, capillary blood glucose test and adjustment of insulin regimens.