Intended for healthcare professionals

  1. Education
  2. Insulin for people...
  3. Insulin for people with type 2 diabetes mellitus
Practice Practical Prescribing

Insulin for people with type 2 diabetes mellitus

BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2023-078015 (Published 17 July 2024) Cite this as: BMJ 2024;386:e078015
  1. Natalie Vanderpant, specialist registrar in diabetes and endocrinology1,
  2. Emily Ward, cardiometabolic pharmacist2,
  3. Edward Farrell, general practitioner and diabetes primary care network diabetes lead3,
  4. Aikaterini Theodoraki, consultant physician in diabetes and endocrinology4
  1. 1Department of diabetes and endocrinology, Imperial College Healthcare NHS Trust, London, UK
  2. 2Chelsea and Westminster NHS Foundation Trust, London
  3. 3Shirland Medical, Queens Park Health Centre, London
  4. 4Department of diabetes and endocrinology, Chelsea and Westminster NHS Foundation Trust, London
  1. Correspondence to: N Vanderpant natalie.vanderpant{at}nhs.net

What you need to know

  • Explain the role of the multidisciplinary team in supporting patients who are starting insulin

  • Basal insulin is the most convenient initial insulin therapy, with an initial starting dose estimated on body weight (0.1-0.2 units/kg/day)

  • Patients with an elevated HbA1c who are taking a basal insulin in combination with appropriate oral medication may require a prandial insulin, either in addition to basal insulin or converting to a pre-mixed insulin regimen

  • Emphasise the importance of blood glucose monitoring to ensure safe use and titration of insulin

A 55 year old woman with type 2 diabetes (T2DM) consults you at her annual diabetes review. Her HbA1c has increased to 90 mmol/mol (10.4%, target <53 mmol/mol or 7.0%) from 72 mmol/mol (8.7%). Since diagnosis at the age of 31, she has been taking oral diabetes medications including metformin, dapagliflozin, and gliclazide. Her current body mass index (BMI) is 26.0 kg/m2. She has expressed apprehension about starting insulin therapy. Following a recent diagnosis of pre-proliferative retinopathy, she is now open to starting insulin therapy. In collaboration with her, you are exploring the option of insulin to optimise her diabetes management.

How often is insulin prescribed for T2DM, and how does it work?

Worldwide, about 537 million adults have type 1 or type 2 diabetes mellitus, representing approximately 10.5% of the world’s adult population.1 In the UK, around 7% of the population (4.7 million people) have a diagnosis of diabetes, 90% of whom have T2DM.2 It is estimated that 15% of people with T2DM require insulin, but only half are appropriately treated because of barriers to insulin availability such as regulatory challenges and issues with supply chains and cost.3

National and international professional guidelines recommend insulin therapy for adults with T2DM when:

  • Dual therapy with metformin and another oral drug has not continued to control HbA1c to below the person’s …

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