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Grand Rounds 06/24/15 @ BID-Needham: Dr. Richard S. Beaser  

Treatment of Type 2 Diabetes: When Insulin Replacement Therapy is Needed
Last Updated: Jul 29, 2015 URL: http://bidmc.libguides.com/Beaser/2015 Print Guide RSS Updates
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Speaker: Date: Topic

Richard S, Beaser, MD

Jun 24, 2015

Treatment of Type 2 Diabetes: When Insulin Replacement Therapy is Needed

      

    Responsibility for Content

    The PowerPoint presentation, Take-Away points, and Article links were sent by Medical Library Services and the CME Committee.

    Diane E. Young, Information Specialist

    dyoung3@bidmc.harvard.edu

     

     

     

        

      Take-Away Points of the Presentation

      • For insulin treatment of type 2 diabetes, when basal insulin alone is not providing adequate glycemia control, options for therapeutic advancement include adding a GLP-1 receptor agonist, changing to fixed mixture insulin, adding bolus insulin before one meal (“basal plus”) or going to a full basal/bolus program with basal insulin plus bolus insulin doses before each meal.

       

      • A clinical estimation of the predominance of the various underlying pathophysiologic mechanisms for hyperglycemia in any give patient is useful in deciding which insulin advancement program would be best.  In making that determination, use of A1C and glycemic patterns can be helpful.  Further, consider patient comorbidities, self-care abilities, and perspectives in designing subsequent treatment advancement.

       

      • All patients should have potential access to all current insulin replacement treatment designs and equipment.  Each clinician treating people with diabetes who need, or could potentially need, insulin replacement treatments should be aware of the spectrum of, and indications for, treatments now available, from basal insulin only to insulin pumps and continuous glucose monitors.   All such clinicians should, if they are not able to provide this spectrum of care directly in their practice, at least understand that these treatments exists, why they might be indicated, and how to recognize the presence of problems with therapy.  They should plan a process by which they can coordinate support of these treatments with area specialty centers. 

          
         

        Links to Articles Cited in the Presentation

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