This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

NICE guidance - the use of long-acting insulin analogues for the treatment of type 2 diabetes - insulin glargine and insulin detemir

Authoring team

  • initiation of insulin therapy in type 2 diabetes:

    • insulin therapy may be indicated
      • when other measures no longer achieve adequate blood glucose control (to HbA1c < 7.5% or other higher level agreed with the individual)
      • when starting insulin therapy, use a structured programme employing active insulin dose titration that encompasses:
        • structured education
        • continuing telephone support
        • frequent self-monitoring
        • dose titration to target
        • dietary understanding
        • management of hypoglycaemia
        • management of acute changes in plasma glucose control
        • support from an appropriately trained and experienced healthcare professional

      • when starting insulin therapy in adults with type 2 diabetes, continue to offer metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies

      • NICE suggest that insulin therapy should be initiated from a choice of a number of insulin types and regimens.
        • preferably begin with human NPH insulin, taken at bed-time or twice daily according to need
          • which insulin to choose?
            • initiate insulin therapy from a choice of a number of insulin types and regimens
              • begin with human NPH insulin injected at bed-time or twice daily according to need
              • consider, as an alternative, using a long-acting insulin analogue (insulin detemir, insulin glargine) if:
                • who do not reach their target HbA1c because of significant hypoglycaemia or
                • who experience significant hypoglycaemia on NPH insulin irrespective of the level of HbA1c reached or
                • who cannot use the device needed to inject NPH insulin but who could administer their own insulin safely and accurately if a switch to one of the long-acting insulin analogues was made or
                • who need help from a carer or healthcare professional to administer insulin injections and for whom switching to one of the long-acting insulin analogues would reduce the number of daily injections

        • when to consider twice-daily biphasic human insulin rather than once daily insulin
          • consider twice-daily biphasic human insulin (pre-mix) regimens in particular where HbA1c is elevated above 9.0%
            • however note that a once-daily regimen may be an option when initiating this therapy

            • consider pre-mixed preparations of insulin analogues rather than pre-mixed human insulin preparations when:
              • immediate injection before a meal is preferred, or
              • hypoglycaemia is a problem, or
              • blood glucose levels rise markedly after meals

        • monitoring if on a once daily insulin regime
          • monitor a person on a basal insulin regimen (NPH insulin or a long-acting insulin analogue [insulin detemir, insulin glargine]) for the need for short-acting insulin before meals (or a pre-mixed insulin preparation)
        • monitor a person using pre-mixed insulin once or twice daily:
          • monitor a person who is using pre-mixed insulin once or twice daily for the need for a further injection of short-acting insulin before meals or for a change to a regimen of mealtime plus basal insulin, based on NPH insulin or long-acting insulin analogues (insulin detemir, insulin glargine), if blood glucose control remains inadequate

Treatment with combinations of medicines including SGLT-2 inhibitors may be appropriate for some people with type 2 diabetes; see the NICE guidance on canagliflozin in combination therapy for treating type 2 diabetes, dapagliflozin in combination therapy for treating type 2 diabetes and empagliflozin in combination therapy for treating type 2 diabetes.

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.