Multiple-dose insulin injection therapy in patients with type 2 diabetes using a basal-bolus regimen, team management, and nutrition education

We determined the efficacy of basal-bolus insulin therapy delivered through team education and nutrition counseling for management of type 2 diabetes in 17 patients treated with a regimen of once-daily insulin glargine and either insulin aspart or lispro three times a day. They received written instructions and specific education about ‘basalbolus’ insulin administration, use of a ‘forced-titration’ schedule for glargine dose adjustment, and calculation of rapid-acting pre-meal bolus insulin. The average hemoglobin A1c level decreased from 8.7 ± 2.06% to 7.0 ± 1.07%, a significant reduction of 1.7% (p<0.05) over 3 months or more. 7 patients (41%) reported improvement in hypoglycemic events. In conclusion, an intensive multidose basal-bolus insulin treatment using self-titration and flexibility through carbohydrate counting confers beneficial effects in patients with type 2 diabetes, including better glycemic control and reduced hypoglycemia. These results are best achieved through multidisciplinary patient care involving the nurse educator and dietician as part of a diabetes care team.