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    Type 2 Diabetes: How to Start Insulin

    Once-Daily Insulin May Be a Starting Point, Study Suggests
    WebMD Health News
    Reviewed by Louise Chang, MD

    Oct. 24, 2007 -- Do you have type 2 diabetes and need to start taking insulin? Scientists have new insights on how you should do so.

    Taking insulin once daily at bedtime may be a first step, with fewer risks than other insulin-dosing strategies, a new study shows.

    Those findings are preliminary, so patients should ask their doctors what they recommend.

    But diabetes experts are certain of this: Get your hemoglobin A1c below 7% to cut your risk of heart attack, stroke, and other diabetes complications -- and if that means taking insulin, so be it.

    What Is Hemoglobin A1c?

    Your hemoglobin A1c number shows how well your blood sugar has been controlled for the past two to three months. The goal for hemoglobin A1c should be less than 7%.

    If type 2 diabetes patients can't reach that goal with a healthy lifestyle and oral medications, they may need to start giving themselves insulin shots.

    The new study included some 700 type 2 diabetes patients in the U.K. and Ireland.

    The patients were taking the maximum dose of the oral drug metformin (sold generically and as Glucophage) and a class of diabetes pills called sulfonylureas, which include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, Amaryl, Dymelor, Diabinese, Orinase, and Tolinase,

    But despite taking those diabetes drugs, the patients' hemoglobin A1c levels were still too high, measuring 7% to 10%.

    Insulin for Type 2 Diabetes

    All of the patients started taking insulin, but they took it in one of three different ways:

    • Twice daily
    • Three times daily with meals
    • Once daily at bedtime

    After taking insulin for a year, some of the patients met their hemoglobin A1c goal.

    That goal was met by 17% of the patients taking insulin twice daily, nearly a quarter of those taking insulin with meals, and 8% of those taking insulin once daily at bedtime.

    Once-Daily Insulin

    There was a fine line to tread with insulin to avoid dangerously low blood sugar (hypoglycemia) and weight gain.

    The patients who took insulin once daily at bedtime were the least likely to gain weight or have hypoglycemia during their first year of taking insulin.

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