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The Insulin Regimen That Works

Authors: Svitlana Crawley; Susan Chaney;

The Insulin Regimen That Works

Abstract

Background: Type 2 diabetes mellitus requires monitoring patients’ glycemic control. Treatment must be escalated if glucose levels remain above the recommended goal in patients who are adherent to their current treatment. If glycosylated hemoglobin (HbA1c) levels remain unmet with maximum doses as recommended by the American Diabetes Association (ADA) after adding basal insulin, but fasting blood glucose is at goal, one to three injections daily of rapid-acting insulin are typically added to the treatment plan to be injected prior to meals while continuing all other antihyperglycemic medications. Objective: To describe an effective method of intensifying insulin therapy based on patients’ needs and abilities to self-manage their medications. Methods: We retrospectively reviewed the case of a patient who was referred to the Endocrinology Specialty Clinic for diabetes management. Results: Diabetes control was improved after intensifying insulin therapy by adding once-daily rapid-acting insulin injections. Conclusions: Intensifying insulin therapy by adding one dose of rapid-acting insulin prior to meals can improve HbA1c to < 7% in patients on maximum doses of basal insulin whose fasting blood glucose is at goal but whose HbA1c is above goal. Implications for Nursing: Nurse practitioners must use current care guidelines supported by evidence-based literature to improve patients’ outcomes. This case study supports ADA recommendations on early intensification of antihyperglycemic therapy in diabetic patients to decrease the risk of complications by achieving and maintaining HbA1c goals early.

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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