1. Insulin Initiation and Titration for Family Physicians: Case Study #2: Andy Alice Y.Y. Cheng, MD FRCPC Peter Lin, MD CCFP

2. Case Study #2: Andy Patient history and presentation 68 years old, retired, regimented lifestyle Type 2 diabetes for 10 years A1C = 8.2% Weight = 90 kg Maxed out on oral agents You have been discussing insulin, but he has been resistant to the idea of injections

3. Andy’s SMBG Logbook BreakfastLunchDinner BeforeAfterBeforeAfterBeforeAfterBedtime Sunday8.110.213.1 Monday8.213.19.98.4 Tuesday7.910.18.18.7 Wednesday8.812.812.98.5 Thursday10.5

4. Type 2 Diabetes: Insulin Choices 1. 1.Basal 2. 2.Basal plus bolus 3. 3.Pre-mixed twice daily

5. Why Choose Pre-mixed Insulin? Regimented/fixed lifestyle Fixed meal plan, i.e., 3 meals per day, at the same time each day Consistent physical activity regimen Blood glucose elevations throughout the day, not just in the fasting state For those who dislike multiple injections (basal + bolus regimen)

6. DOSING SEE REVERSE FOR TIPS CHOOSE AN INSULIN CATEGORY CHOOSE A BRAND

8. Pre-mixed Insulin Dosing and Titration 10 1 1 4.0 – 7.0 1 1