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 LogbookBreakfast Lunch Dinner
Before After Before After Before After Bedtime
Sunday 8.1 10.2 13.1
Monday 8.2 13.1 9.9 8.4
Tuesday 7.9 10.1 8.1 8.7
Wednesday 8.8 12.8 12.9 8.5
Thursday 10.5
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)
DOSINGSEE REVERSE FOR TIPS
CHOOSE AN INSULIN CATEGORY
CHOOSE A BRAND
Pre-mixed Insulin Dosingand Titration
10
10
1
14.0 – 7.0
1
1
4.0 – 7.0
