708 Management of Uncontrolled Diabetes (Combination Therapy)

When combinations of oral agents fails and insulin is to be used:
Oral treatment should continue to reduce dosage of insulin

When combinations of oral agents fails and insulin is to be used:
For those with BMI<30, a bedtime NPH (Intermediate acting insulin) / Long-acting insulin should be considered to control fasting glucose

When combinations of oral agents fails and insulin is to be used:
For those with BMI>30, a 70/30 insulin mixture before dinner should be considered to control both post-prandial and fasting glucose

When combinations of oral agents fails and insulin is to be used:
A rough guide for initial insulin dose is dividing the average FPG by 18

When combinations of oral agents fails and insulin is to be used:
A rough guide for initial insulin dose is dividing the body weight in kg by 10

The benefits of combining oral agents with insulin include:
Increased hepatic levels of endogenous insulin and meeting meal-related insulin requirements with sulphonyl ureas

The benefits of combining oral agents with insulin include:
Improved insulin sensitivity at the liver and reduced hepatic glucose production by metformin

The benefits of combining oral agents with insulin include:
Improved insulin action in peripheral tissues and enhanced glucose uptake by glitazones

The benefits of combining oral agents with insulin include:
Decreased postprandial glucose absorption by alpha-glucosidase inhibitors

Benefits of combining insulin and metformin include:
Better glycaemic control

Benefits of combining insulin and metformin include:
Less weight gain

Benefits of combining insulin and metformin include:
Lower cardiovascular risk

Benefits of combining insulin and metformin include:
Less increase in fasting insulin levels

Benefits of combining insulin and metformin include:
Less frequency of hypoglycemia as compared to insulin and SU or twice daily insulin injections

Benefits of combining insulin and metformin include:
Less insulin requirement

Combining day time sulphonyl urea with bedtime insulin leads to:
Less weight gain

Combining day time sulphonyl urea with bedtime insulin leads to:
Lower insulin serum concentrations

Combining day time sulphonyl urea with bedtime insulin leads to:
Better glycemic control

Combining day time sulphonyl urea with bedtime insulin leads to:
Lesser insulin dosage

Combining insulin with SGLT2 inhibitors
Should be considered in all patients not achieving preconceived glycaemic goals on metformin monotherapy

Combining insulin with SGLT2 inhibitors
Patients with type 2 diabetes and high risk of heart failure

Combination insulin with an incretin should be considered in
Patients with hypertension and type 2 diabetes

Combination insulin with an incretin should be considered in
Patients with diabetes and obesity class III

Multiple insulin injections are not suitable for elderly patients due to:
Varied meal patterns

Multiple insulin injections are not suitable for elderly patients due to:
Varied meal patterns