 |
Diabetes mellitus
Assessment of Type 2 patients for insulin
|
Type 2 patients on maximum oral agents may require transfer to insulin to
attain acceptable levels of glycaemia. To guarantee the greatest likelihood of
this, pre-insulin assessment and support should be carried out. The aim of this
will be to maximise a aspects of self-management and to reduce levels of weight
gain should insulin transfer be required.
Maximum oral agents:
- Glibenclamide l5mgs or Tolbutamide 1gm bd or Gliclazide l60mgs bd.
- Metformin 1g tds.
- Acarbose (according to tolerance)
- Rosiglitazone (4mg od with sulphonylurea, 8mg od with Metformin)
The Team:
- All members of the 'Team' will be involved in pre-insulin assessment,
- The patient should be made aware of the possibility of the need for
insulin from an early stage.
- The patient is a member of the team and should be encouraged to have
ownership of their own diabetes.
Key messages promoted by the team:
- Diabetes is a progressive condition and it is likely that in most patients
insulin will be required.
- Insulin therapy does not mean a ~more serious type of diabetes'.
- Ideally the trend in weight should be static or downward before insulin
therapy is considered.
- Maximising all aspects of self-management may delay the insulin transfer.
- Lifestyle (food and exercise) changes, made pre-insulin will be necessary
to either:
- Manage diabetes without insulin or
- To attain good HbA1c results without excessive weight gain using
insulin.
- Insulin alone does not guarantee good HbA1c results.
Source: Northumbria NHS Health Care Trust diabetes protocol