Shopping for basal insulin on the coffee aisle: Lots of choices for lots of tastes

SummaryEven the finest coffee bean in the world, if used in the wrong proportion to water, yields a substandard cup of java. The coffee must be used in the right mixture to yield a really satisfying brew. The same principle is true for insulin. Too little produces a weak, ineffective result that doesn't get the job done; too much causes a different set of problems (hypoglycemia and weight gain). It's good when it's balanced. Regardless of the basal insulin chosen, the clinician should be committed to using enough to produce a pleasing result (fasting blood glucose of 100–110 mg/dL) without overdoing it (inducing hypoglycemia or excessive weight gain). A commitment to conscientiously address one of the major components of broken physiology (underproduction of basal insulin in a setting of increased need because of insulin resistance) by adequately replacing what's missing (basal insulin) likely is of greater impact than the actual agent chosen to fill that basal insulin gap. It's all about finding a comfortable and effective therapeutic tool and then routinely and systematically using that tool for the benefit of your patients. And with that thought, I think I'll wander into the kitchen and use my very predictable old coffeemaker to make myself a satisfying cup of joe.