Therapeutic Options
ÎÎLifestyle
• Weight optimization
• Healthy diet
• Increased activity level
ÎÎOral agents & noninsulin injectables
• Metformin
• Sulfonylureas
• Thiazolidinediones (TZDs)
• Dipeptidyl peptidase 4 (DPP-4) inhibitors
• Glucagon-like peptide 1 (GLP-1) receptor agonists
• Meglitinides
• α-Glucosidase inhibitors
• Bile acid sequestrants
• Dopamine-2 agonists
• Amylin mimetics
ÎÎInsulin
• Neutral protamine Hagedorn (NPH)
• Regular
• Basal analogues (glargine, detemir)
• Rapid analogues (lispro, aspart, glulisine)
• Pre-mixed varieties
ÎÎImplementation strategies (see Figure 6)
• Initial drug therapy
• Advancing to dual combination therapy
• Advancing to triple combination therapy
• Transitions to and titrations of insulin
Figure 5. Insulin Options
Insulin
level
Rapid (Lispro, Aspart, Glulisine)
Short (Regular)
Intermediate (NPH)
Long (Detemir)
Long (Glargine)
Hours
0
2
4
6
8
10
12
14
16
18
20
22
24
Hours
a(er
injec.on
© American Diabetes Association.
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