When to Start People with Diabetes on Insulin

When to start patients on insulin¹

Offer basal insulin as the initial insulin therapy to adults with type 2 diabetes. Consider combining basal and short acting insulin as the initial insulin therapy for adults with type 2 diabetes, especially if the person's HbA1c is 75 mmol/mol (9.0%) or higher. This should be injected either separately or as a pre-mixed (biphasic) preparation.

Practical information for starting patients on Toujeo (insulin glargine U/300mL)¹

NICE guidelines advise providing a structured education programme to adults with type 2 diabetes starting insulin therapy. The programme should include:

• Injection technique, including rotating injection sites and avoiding repeated injections at the same point within sites

• Self-monitoring

• Dose titration to target levels

• Dietary advice

• Managing hypoglycaemia

• Managing acute changes in plasma glucose control

• Support from a healthcare professional trained in insulin therapy.

When initiating insulin for adults with type 2 diabetes:

• Continue to offer metformin to people already taking it

• Stop any other medicines being used solely to manage hyperglycaemia

• Discuss with the person the risks and benefits of continuing medicines for other benefits such as cardiovascular protection or weight management 

Choosing an insulin¹

Make a shared decision with the person on the choice of basal insulin preparation, based on considerations that are specific to them, including whether:

• The person needs help from a carer or healthcare professional to inject insulin or

• There is a particular concern about nocturnal hypoglycaemia or

• The person has a strong preference for once-daily injections.