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Type 2 Diabetes Management Guidelines

Premixed insulin

  • Clear instructions for patients on how to administer and self-titrate bolus insulin
  • Essential particularly if concerns over cognitive impairment (medication oversight may be required)
  • Administer before meals
  • Patients should be advised that they will likely need to reduce the dose of premixed insulin if they are having significantly less than normal intake at that meal
  • Patients should have different coloured pens for their different types of insulin
  • Use BD fine 4 or 5 mm needles as associated with better absorption and less pain/trauma
  • Encourage rotation of injection sites
  • Explain that doses of premixed insulin may need to be reduced for meals immediately before and after strenuous exercise
  • Memory adjuncts (e.g. NovoPen Echo; InsulCheck etc.) may be useful
  • Converting from premixed insulin to basal bolus regimen
  • Convert daily dose of premixed insulin to 50% as once daily basal insulin and 50% as bolus insulin split between meals
  • E.g. Premixed insulin 25 units mane 35 units nocte → 30 units basal insulin nocte + 10 units of bolus insulin with meals
  • May need to alter starting doses of bolus insulin based on different meal sizes across the day
  • Titrate doses of basal and bolus insulin as required
  • The doses of premixed insulin will likely need to be reduced if major changes in diet (e.g. Ramadan) or if new glucose lowering therapies are added to the regimen