insulin titration case study william

Insulin Initiation and Titration for Family Physicians: Case Study #1: William Alice Y.Y.. Case Study #1: WilliamPatient history and presentation • 59-year-old male stockbroker • Type 2

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Insulin Initiation and Titration

for Family Physicians:

Case Study #1: William

Alice Y.Y Cheng, MD FRCPC

Peter Lin, MD CCFP

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Patient history and presentation

• 59-year-old male stockbroker

• Type 2 diabetes x 8 years

• Weight = 90 kg

• A1C = 7.9%

• He is on metformin, an insulin secretagogue and

a TZD – he is at the maximum dose of all three

oral agents

• You have been proposing that he start insulin during the past few visits in the last year, and he is now becoming more

agreeable to the idea

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William’s SMBG Logbook

Breakfast Lunch Dinner

Before After Before After Before After Bedtime

Thursday 8.8 8.5

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Case Study #1: William (cont’d)

Case review

• William has suboptimal glycemic control,

according to the guidelines

• He is maxed out on oral agents

• He continues to have high BG levels,

particularly in the morning

• What insulin regimen would you prescribe?

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Type 2 Diabetes: Insulin Categories

1 Basal

2 Basal plus bolus

3 Pre-mixed twice daily

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Case Study #1: William (cont’d)

• The easiest insulin to start would be basal insulin at bedtime, which has the advantage of a single

injection – so it is easy to remember

• At this point, the TZD should be discontinued (to

minimize risk of edema); however, the metformin

and insulin secretagogue can both be continued

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SEE REVERSE FOR TIPS

CHOOSE

AN INSULIN

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