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Insulin treatment for type 2 diabetes

For some people living with type 2 diabetes, the pancreas makes very little insulin by itself. In this case, your doctor may recommend that you start insulin treatment to help your body absorb glucose. There are different insulin treatment options and your routine will be tailored to your specific needs.

Insulin types differ in three ways

How quickly they work

(onset of action)

When they have the greatest effect

(time of peak action)

How long they work

(duration of action)

It is important to be aware that there are different types of insulin. Depending on your needs, your doctor will recommend that you begin on one type of insulin. Your treatment may need to be adjusted over time to achieve the best possible blood sugar control. 

Long-acting insulin

Most people with type 2 diabetes who move on to insulin treatment start with a long-acting insulin. These are often called basal or 'background' insulins because they keep a low, consistent level of insulin in your blood over an extended time.

Long-acting insulins work to keep your blood sugar levels steady throughout the entire day – including between meals and when you sleep. Because of their long duration of action, they are usually taken only once or twice daily.

Mealtime insulin

Diagnosed with type 2 diabetes your blood sugar rises rapidly when you eat a meal. Sometimes, long-acting insulin isn't enough to control these 'spikes' and you may need to add mealtime insulin to keep your blood sugar levels under control.

Mealtime insulin is a rapid- or fast-acting insulin that you inject just before you eat to manage blood sugar spikes. It is taken in addition to a long-acting insulin and together, they are sometimes called 'basal-bolus insulin'.

You may start with just one mealtime insulin injection per day, usually with your main meal. Your doctor will advise you to add more mealtime injections if necessary.

Starting insulin treatment for type 2 diabetes

Regardless of the type of insulin you are prescribed, moving on to insulin treatment can seem overwhelming. You may be worried about injections, or even see it as a personal failure. These are quite normal reactions. At the same time, it is important to keep in mind that type 2 diabetes is a progressive disease and switching to a treatment that gives you better control of your health is a success on its own terms. 

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References
  1. Diabetes.co.uk. Basal Bolus - Basal Bolus Injection Regimen. Available from: https://www.diabetes.co.uk/insulin/basal-bolus.html Last accessed: January 2022.
  2. Diabetes.co.uk. Pancreas and diabetes. Available from: https://www.diabetes.co.uk/body/pancreas-and-diabetes.html Last accessed: January 2022.
  3. Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020; 43:487–493.
  4. CDC. Types of Insulin. Available from: https://www.cdc.gov/diabetes/basics/type-1-types-of-insulin.html Last accessed: January 2022.
  5. Diabetes.co.uk. Starting on Insulin in Type 2 Diabetes. Available from: https://www.diabetes.co.uk/insulin/starting-on-insulin-in-type-2-diabetes.html Last accessed: January 2022.
  6. Diabetes.co.uk. Blood Glucose. Available from: https://www.diabetes.co.uk/diabetes_care/diabetes_and_blood_glucose.html Last accessed: January 2022.
  7. NHS. About Insulin. Available from: https://www.nhs.uk/conditions/type-1-diabetes/about-insulin/ Last accessed: January 2022.

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