Individualized management of a patient’s insulin regimen is a must. It is not without many challenges, however, as Richard Beaser, MD, Associate Clinical Professor of Medicine at Harvard Medical School, George Dailey III, MD, Head of Diabetes Research and Medical Director of the Scripps Whittier Diabetes Institute, and Jason Gaglia, MD, MMSc, Assistant Professor of Medicine at Harvard Medical School discuss in the presentation “Strategies and Considerations for Individualized Insulin Replacement Therapy.”
The purpose of this video presentation is to help medical providers identify which insulin therapies can benefit their diabetic patients, with diabetes and when to use those therapies. Although there are urgent indications for when a patient with type 2 diabetes should start insulin therapy, not all scenarios are cut-and-dry. This is particularly true for patients who are skeptical about initiating insulin therapy. In the video, the presenters discuss key indicators of when physicians may need to consider recommending insulins to their patients.
With the availability of short-acting to long-acting and even inhaled insulins, the wide variety of available treatments can be daunting, according to Dr. Gaglia.
Set the Appropriate Goals for the Individual Patient
Dr. Dailey discusses how the goals for insulin treatment can vary based on the organization defining them. For example, the American Diabetes Association and the American Association of Endocrinologists have two separate sets of guidelines for insulin therapy goals.
Not every patient needs very tight glycemic controls, nor will they benefit from them, according to Dr. Gaglia.
Dr. Gaglia explains. “So if damage has already been done – macrovascular complications, microvascular complications, it’s a lot harder to reverse that . . . But if I have a young individual who’s just diagnosed with diabetes, . . . I might want much tighter control.”
Evaluate Existing Therapies and Look Ahead to the Future
From basal insulins to GLP-agonists, a medical provider has many options for treatment therapies. In the video, presenting physicians weigh the risks and the benefits and discuss the best practices of each option. In addition to these therapies, patients may need education on carbohydrate counting, which would allow them to make insulin adjustments based on foods consumed.
“Often the assistance of a dietitian is needed in this regard—this is not easy to learn,” Dr. Dailey explains. “There are some useful books and smartphone apps, for example, that can be very helpful with the patients, but they need some hands-on experience.”
Patients may use carbohydrate counting along with a continuous monitoring insulin pump. These pumps measure the interstitial fluid between cells, which generates significant data to help physicians determine insulin patterns.
In addition to these therapies, the physicians discuss innovative therapies, including insulin glargine-300, rapidly acting inhaled insulin and the U200 insulin lispro pen.
“There’s a number of exciting things coming down the pipeline in terms of type 2 diabetes treatments in the insulin realm,” Dr. Gaglia says.
This session is part of a three-part series. You can also view Nancy Bohannon, MD, St. Luke’s Hospital, discuss insulin replacement.
To learn more about how you can help your patients better manage their diabetes and to earn CME credits, view “Strategies and Considerations for Individualized Insulin Replacement Therapy” on DiabetesSeries Live.
Disclaimer: “All PlatformQ Health articles, reports, summaries, and recaps of events are for informational purposes only. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.”
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