Type 2 Diabetes: How to Start Insulin
Once-Daily Insulin May Be a Starting Point, Study Suggests
Oct. 24, 2007 -- Do you have type 2 diabetes and need to start taking
insulin? Scientists have new insights on how you should do
Taking insulin once daily at bedtime may be a first step, with fewer risks
than other insulin-dosing strategies, a new study shows.
Those findings are preliminary, so patients should ask their doctors what
But diabetes experts are certain of this: Get your hemoglobin A1c below
7% to cut your risk of heart attack, stroke, and other diabetes complications
-- and if that means taking insulin, so be it.
What Is Hemoglobin A1c?
Your hemoglobin A1c number shows how well your blood sugar has been
controlled for the past two to three months. The goal for hemoglobin A1c should
be less than 7%.
If type 2 diabetes patients can't reach that goal with a healthy lifestyle
and oral medications, they may need to start giving themselves insulin
The new study included some 700 type 2 diabetes patients in the U.K. and
The patients were taking the maximum dose of the oral drug metformin (sold
generically and as Glucophage) and a class of diabetes pills called
sulfonylureas, which include Glucotrol, Glucotrol XL, DiaBeta, Micronase,
Glynase PresTab, Amaryl, Dymelor, Diabinese, Orinase, and Tolinase,
But despite taking those diabetes drugs, the patients' hemoglobin A1c levels
were still too high, measuring 7% to 10%.
Insulin for Type 2 Diabetes
All of the patients started taking insulin, but they took it in one of three different ways:
- Twice daily
- Three times daily with meals
- Once daily at bedtime
After taking insulin for a year, some of the patients met their hemoglobin
That goal was met by 17% of the patients taking insulin twice daily, nearly
a quarter of those taking insulin with meals, and 8% of those taking insulin
once daily at bedtime.
There was a fine line to tread with insulin to avoid dangerously low blood
sugar (hypoglycemia) and weight gain.
The patients who took insulin once daily at bedtime were the least likely to
gain weight or have hypoglycemia during their first year of taking insulin.
The study still has two more years to go.
But based on the first year's results, once-daily insulin may be an
appropriate first step, though insulin doses may need tweaking later, according
to the researchers.
They included Rury Holman, MB, ChB, FRCP, of Oxford University's Diabetes
Why didn't more patients meet the hemoglobin A1c goal? A journal editorial
suggests two possibilities:
- Insulin doses may not have been perfect during the study's first year.
- The patients may have needed more help in making healthy lifestyle
Graham McMahon, MD, MMSc, and Robert Luhy, MD, wrote the editorial. They're
editors at The New England Journal of Medicine.
The study was funded by Novo Nordisk, which also provided the insulin drugs.
Holman and several colleagues report ties to drug companies including Novo
The editorialists note no potential conflicts of interest.