Initiating insulin therapy in the outpatient department

ABSTRACT

OBJECTIVE: To evaluate the safety of starting insulin therapy in type 2 diabetics in a sub-optimal outpatient setting and to evaluate the efficacy of the use of a specific regime. METHODS: Hyperglycaemic patients who require insulin to attain euglycaemia are usually hospitalised. Close monitoring is done to identify hypoglycaemia. We identified 20 patients with type 2 diabetes mellitus who remained hyperglycaemic despite maximum dosages of a sulphonylurea and a biguanide plus or minus an alpha glucosidase inhibitor and who had been switched to insulin at the Diabetes Clinic of the University Hospital of the West Indies over a 3-year period. All patients had been started on human (recombinant DNA) 70/30 mixed insulin at the dose of 15 units per day. Data pertaining to insulin dose needed to attain eculycaemia, number of hospital visits necessary during this period and the complications of weight gain and hypoglycaemia were collected. RESULTS: Eighty-five per cent of patients were females. It required 55 (SD ñ 20.8) units per day to attain euglycaemia. More than 5 weekly/biweekly visits to the clinic for evaluation were necessary but the cost of this was significantly lower than if they had been hospitalized for the same procedure. Hypoglycaemia was minimal and insignificant. CONCLUSION: Despite sub-optimal conditions outpatient conversion to insulin is safe and cost-effective.(Au)