Long-Acting Insulins Useful Tools in Type 1 and Type 2 Diabetes
Researchers have augmented insulin's effectiveness with several rapid and long-acting analogues and new delivery systems such as insulin pens and insulin pumps. Biosynthetic preparations with various pharmacokinetic profiles somewhat mimic the steady insulin release from a normal pancreas. Long-acting insulins create unprecedented prescribing flexibility, as prescribers can tailor patients' regimens to their individual activity levels, eating habits, and responses to insulin.
Insulin is a necessity for patients who have type 1 diabetes (T1D). For many people who have type 2 diabetes (T2D), insulin can improve glycemic control significantly. Still, many clinicians are reluctant to initiate injectable glucose-lowering therapies in T2D. They often perceive, rationally or irrationally, that patients will have difficulty understanding complex regimens. Many clinicians also report that they are less proficient than they would like with insulin, creating discomfort with diabetes management.1 And they perceive that multidose insulin regimens may be associated with increased episodes of hypoglycemia, though they are not.2 However, today's long-acting insulins such as insulin detemir, insulin glargine (IGlar), and insulin degludec (IDeg) offer convenience that increases adherence significantly (Table 13-7). They also tend to have fewer adverse effects, which can simplify patients' regimens and improve control.3-7
Designing a Regimen
For most patients, designing an optimal insulin regimen is a continuing process that may require formulation changes, dose-related fine tuning, and intro Continue reading