When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
1. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
2. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
3. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
4. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.
Question 2
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
1. The initial dose of glargine is reduced by 20 to avoid hypoglycemia.
2. The initial dose of glargine is 2 to 10 units per day.
3. Patients who have been on high doses of NPH will need tests for insulin antibodies.
4. Obese patients may require more than 100 units per day.
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