10 A

No. The advice is not correct.

Initiating insulin for long term control of Type 2 diabetes should be done by using a basal insulin (long acting insulin or biphasic insulin) given once a day, preferably at night. The starting dose is 0.2units per kg body weight.

If a long acting insulin like Insulatard is used, it can be given at bedtime (or before dinner). However, if a biphasic insulin (like Humulin 30/70) is used, it must be given before dinner only. It can be given at bedtime if the patient is in the habit of taking a snack at bedtime.

When initiating insulin as part of the BIDS regimen, it is probably safer to discontinue sulphonylurea drugs until the effect of the insulin on the blood sugar has been observed. The sulphonylurea can be added in a low dose, if necessary, later. Metformin can be continued.

For the patient in this question, a prescription like:
Injection Humulin 30/70 insulin 12 units sc before dinner plus Tab Metformin 1000mg BD would be an appropriate way to initiate insulin. Based on subsequent monitoring of plasma glucose, the doctor may decide to increase the dose of insulin or to add a small dose of a sulphonylurea.



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