What kind of insulin is right for someone with type 2 diabetes?

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Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
For most people, the type of insulin that should be used first depends upon when during the day their blood sugar is not well-controlled. By “when,” I don’t mean the time on the clock, I mean whether the sugar is at its most poorly-controlled when the person is fasting or after they have been eating.  

Many patients have very high sugars when they first awaken in the morning. They have “fasting hyperglycemia,” and they typically find that their blood sugar levels are higher before breakfast than they are before dinner. Often these people are surprised because they have would not have expected to have high glucose values after so many hours without eating. But it turns out that our liver begins to release glucose into the blood stream about 4 to 5 hours after hour last meal. This is so that we do not run out of fuel between meals. In many people with diabetes, however, much too much glucose is released resulting in a very high sugar before eating anything in the morning. These people are best treated with a long-acting or “basal” insulin. This word is derived from “base” or “baseline,” and this kind of insulin provides a baseline or background amount of insulin over a period of 24 hours or more. Because the many non-insulin medications provide better control of the glucose rise that occurs with eating than they do of the glucose release that occurs with fasting, most people with type 2 diabetes who need insulin are first treated with basal or long-acting insulin. 

Long-acting insulins include glargine and determir which are marketed under the brand names Lantus, Toujeo and Levemir.  

For those people whose morning glucose values are generally within an acceptable range but who have a big rise in glucose values after eating, short-acting (also called “bolus”) insulin given with one or more meals of the day may be the best form of insulin.  

Short-acting insulins include the generic form “regular” insulin and the brand-name insulins Humalog, NovoLog and Apidra.  

If a person needs both long-acting and short-acting insulin, they can take the two separately or can sometimes take a pre-mixed form of a short-acting insulin with the intermediate-acting insulin NPH. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.