Optimizing Insulin Use in Type 2 Diabetes: Role of Basal and Prandial Insulin in Long-Term Care Facilities

Oral antidiabetic drugs (OADs) represent first-line pharmacotherapy for diabetes. However, because of the progressive nature of type 2 diabetes, most patients will eventually require insulin. Adding a basal insulin analog, such as insulin glargine or insulin detemir, to an OAD is a simple, safe, and effective strategy for introducing insulin therapy. These long-acting insulin analogs provide effective glycemic control with a lower risk of hypoglycemia, a particular concern in the elderly, compared with NPH insulin. In patients whose insulin requirements have increased as a result of increases in post-prandial glucose excursions, prandial insulin should be added following a stepwise approach to therapy. Overall patient care and optimizing treatment of type 2 diabetes and its associated complications are vital services provided by the nursing staff at long-term care facilities.