Effective switch from premixed to basal-prandial insulin to achieve glycemic goals in type 2 diabetes

Abstract

Objective: This article describes a patient with type 2 diabetes mellitus achieving glycemic control after transitioning from premixed to basal-prandial insulin.

Methods: A case report illustrates the challenges of achieving glycemic control in type 2 diabetes, and results of a literature search regarding premixed and basal-prandial insulins are presented.

Results: A 52-year-old obese man with type 2 diabetes for 10 years initiated therapy with 2 oral antidiabetic drugs (OADs). When OAD therapy no longer maintained glycemic targets, and the addition of exenatide proved intolerable, he started premixed insulin aspart 70/30. However, lapses in exercise and irregular meal patterns led to a loss of glycemic control and nocturnal hypoglycemia. Switching to a basal-prandial regimen, starting with basal insulin glargine and then adding prandial insulin glulisine, subsequently resulted in a glycated hemoglobin level of 6.7%.

Conclusion: The patient benefited from the addition of 1 or more prandial insulin injections to a once-daily basal insulin analog.