Insulin Initiation and Titration
for Family Physicians:
Case Study #2: Andy
Alice Y.Y. Cheng, MD FRCPC
Peter Lin, MD CCFP
Case Study #2: Andy
Patient history and presentation
• 68 years old, retired, regimented lifestyle
• Type 2 diabetes for 10 years
• A1C = 8.2%
• Weight = 90 kg
• Maxed out on oral agents
• You have been discussing insulin, but he has been
resistant to the idea of injections
Andy’s SMBG Logbook
Breakfast
Before
Sunday
8.1
Monday
8.2
Tuesday
7.9
Wednesday
8.8
Thursday
After
Lunch
Before
Dinner
After
Before
10.2
13.1
10.1
12.8
After
13.1
9.9
8.4
8.1
8.7
12.9
10.5
Bedtime
8.5
Type 2 Diabetes: Insulin Choices
1. Basal
2. Basal plus bolus
3. Pre-mixed twice daily
Why Choose Pre-mixed Insulin?
• Regimented/fixed lifestyle
• Fixed meal plan, i.e., 3 meals per day, at the
same time each day
• Consistent physical activity regimen
• Blood glucose elevations throughout the day,
not just in the fasting state
• For those who dislike multiple injections
(basal + bolus regimen)
CHOOSE
AN INSULIN
CATEGORY
CHOOSE A
BRAND
DOSING
SEE REVERSE FOR TIPS
Pre-mixed Insulin Dosing
and Titration
10
10
1
1
4.0 – 7.0
1
1
4.0 – 7.0