Type 2 Diabetes: Outpatient Insulin Management

More than 29 million adults in the United States are diagnosed with type 2 diabetes, and insulin therapy is estimated to be needed in up to 15% of cases. Insulin should be considered first-line treatment in patients with severe hyperglycemia (eg, A1C greater than 10%, blood glucose 300 mg/dL or higher), symptoms of hyperglycemia, or catabolism. To optimize insulin use in an outpatient setting, family physicians must consider strategies for initiation, titration, and adherence. The preferred starting regimen is basal insulin with stepwise intensification to prandial or premixed insulin. Insulin regimens can be titrated as frequently as every 2 to 3 days until blood glucose targets are reached. Long-acting insulin analogues offer improved duration of action and reduced risk of hypoglycemia compared with intermediate-acting insulin. Continuous glucose monitoring may improve diabetes control and can be considered in patients who need insulin. Weight gain, hypoglycemia, and insulin regimen complexity are key challenges in diabetes management. Family physicians should use individualized targets that consider life expectancy, age, medical comorbidities, and hypoglycemia risk. Insulin treatment remains a significant but complex aspect of managing type 2 diabetes.