When to Start People with Diabetes on Insulin

Author: By Sanofi

Editorial Team

Key indicators and timing for insulin initiation in Type 2 diabetes care pathways

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

NG28 advises 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
The DVLA’s Assessing ﬁtness to drive: a guide for medical professionals
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.

NG28 states that when multiple basal insulin types (including biosimilars) and regimens meet the person’s needs, choose the one with the lowest acquisition cost.