Patient Case: Intensifying Therapy Beyond Basal Insulin

Patients on basal insulin alone may continue to experience elevated postprandial glucose despite optimised fasting glucose control, indicating an unmet component of overall glycaemic management. This pattern often signals a need for additional mechanisms of action beyond basal insulin coverage. Recognising this gap supports timely escalation rather than repeated basal insulin dose increases alone. The case discussion illustrates how this clinical picture can inform the decision to transition therapy.

Factors supporting transition typically include inadequate glycated haemoglobin control despite basal insulin optimisation, together with evidence of postprandial glucose excursions. Patient preference for a simplified single-injection regimen may also influence the decision compared with adding multiple prandial insulin injections. The case discussion reviews how these factors were weighed in the presented scenario. Individual patient assessment remains essential when applying these considerations to other patients.

Case-based discussion typically reviews changes in glycated haemoglobin, fasting and postprandial glucose, and total daily insulin requirements following transition. Outcomes are illustrative of the mechanism of action rather than guaranteed for all patients, given individual variability in response. Ongoing monitoring after transition remains important to confirm the new regimen is meeting the patient's glycaemic targets. The case is intended to support clinical reasoning rather than replace individualised assessment.