Insulin is in the spotlight...and you can help answer questions.
Medicare Part D now caps insulin co-pays at $35/month. And manufacturers are rolling out their own co-pay caps...and lower prices.
Plus Rezvoglar (insulin glargine-aglr) will soon join Semglee as a lower-cost interchangeable biosimilar for Lantus.
Expect all of these changes to lead to more questions about how to use insulin for patients with type 2 diabetes.
Continue to start basal insulin first-line in some cases...such as if A1c is over 10% or in patients with symptomatic hyperglycemia (polyuria, polydipsia, etc).
Or consider adding insulin if other med combos aren’t enough.
When initiating insulin prior to discharge, usually start with 10 units or 0.1 to 0.2 units/kg once daily of a long-acting analog (glargine, etc) or NPH.
If adding insulin to a patient’s home regimen, evaluate if their other diabetes meds should be adjusted.
Consider continuing GLP-1 agonists (semaglutide, etc), metformin, and SGLT2 inhibitors (empagliflozin, etc) after discharge.
Continuing these meds may help limit weight gain...and allow patients to use lower insulin doses.
And GLP-1 agonists or SGLT2 inhibitors may be used for their CV or kidney benefits in some patients.
It’s also okay to continue gliptins (sitagliptin, etc).
But be cautious about using insulin with pioglitazone...due to possible weight gain, edema, and heart failure.
Stop sulfonylureas once mealtime insulin is added...there’s little added benefit and possibly more hypoglycemia.
Before discharge, work with case management to overcome hurdles...such as payer preferences or patient assistance.
Educate patients about their insulin regimen.
And ensure patients also have discharge Rxs for supplies they’ll need (syringes, pen needles, etc).
See our resource, Tips to Improve Insulin Safety. And access our Diabetes Resource Hub for help with switching, monitoring, and more.
- Diabetes Care. 2023 Jan 1;46(Suppl 1):S140-S157
- Diabetes Care. 2022 Nov 1;45(11):2753-2786
- Checklist: Tips to Improve Insulin Safety
- Technician Tutorial: Dispensing Insulin and Other Injectable Diabetes Meds