Diabetes guidance 1766.pdf - East Cheshire NHS Trust

Insulin therapy - continuedScenario 4 such as an office worker in their 60’sHbA1c is less than 69mmol/mol Hb and has a set meal and work pattern. The patient’s preference is for nomore than one or two insulin injections a day.• Continue with all oral agents unless there is a significant reason to reduce the dose or stop one ormore agents.• Start human NPH insulin (Humulin I, Insulatard or Insuman) at bed time or in the morning at breakfasttime. Adjust doses as needed.• If there is a failure to achieve the HbA1c targets consider making the regimen twice a day i.e., twice a dayof NPH isophane insulin along with oral agents.• Consider human biphasic insulin (like Humulin M3 or Insuman 25) in twice a day regimen, especially ifthere are high excursions of glucose postprandially.• The next step is to consider biphasic analogue insulin (like Novomix 30 or Humalog Mix 25) in a twice aday regimen.• Finally consider a basal bolus regimen with human or analogue insulin.• Oral agents especially metformin and / or pioglitazone should be continued with twice a day biphasichuman or analogue insulin regimens unless there is a reason.Insulin PumpsThe use of insulin pumps for patients who fulfil the criteria stated in NICE TA 151 (July 2008) is supportedlocally. Referrals for assessment of the patient’s current management should be made initially to the DSNteam and then if appropriate, onward referral will be made for local consultant review or directly to theinsulin pump service in Liverpool or Manchester.