Initiating and intensifying insulin therapy in type 2 diabetes mellitus.

Although insulin therapy for type 2 diabetes mellitus is perceived to be challenging to initiate and intensify, it forms a vital part of treatment as the disease progresses. This review discusses the challenges, real and perceived, faced by patients and their carers, and presents some practical suggestions concerning patient education and management of insulin therapy. A positive attitude toward insulin therapy can be achieved through patient education that focuses on disease pathophysiology and active involvement in treatment that enables them to manage concerns such as possible hypoglycemia, weight gain, and injection anxiety. Insulin analogues have more physiologic time-action profiles and are more convenient compared with older human insulins. Clinical trials show that insulin analogue regimens enable glycemic targets to be achieved with potentially less risk for hypoglycemia and more convenient dosing. Furthermore, finer needles and more convenient insulin-delivery systems are now available. With titration algorithms, intensification of an insulin regimen to improve glycemic control is relatively straightforward. Furthermore, patients with type 2 diabetes are less susceptible to hypoglycemia than are those with type 1 diabetes. With modern treatment options, insulin therapy need no longer be feared by patients with type 2 diabetes or their carers. Many common concerns in this respect are unfounded, and today's insulin regimens are generally simple, effective, and well tolerated.