Injectable Therapies in Diabetes Management

Injectable Therapies
in
Diabetes Management

Hengameh Abdi

Endocrine Research Center

Research Institute for Endocrine sciences

Shahid Beheshti University of Medical Sciences

02 May 2019

Initiation for basal insulin

• Basal insulin alone is the most convenient initial insulin regimen and can be added to metformin and other oral agents.
• Starting doses can be estimated based on body weight (e.g., 10 units a day or 0.1-0.2 units/kg/day) and the degree of hyperglycemia, with individualized titration over days to weeks as needed.

Titration for basal insulin

• Patient self titration is more effective.
• Choose evidence-based titration algorithm, e.g. increase 2 units every 3 days to reach FPG target without hypoglycemia.
• For hypoglycemia, determine cause; if no clear reason, lower dose by 10-20%.

An important point

• When initiating combination injectable therapy, metformin therapy should be maintained while sulfonylureas and DPP-4 inhibitors are typically discontinued.