Therapeutic Options ÎLifestyle
• Weight optimization • Healthy diet • Increased activity level
ÎOral 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
ÎInsulin
• Neutral protamine Hagedorn (NPH) • Regular • Basal analogues (glargine, detemir) • Rapid analogues (lispro, aspart, glulisine) • Pre-mixed varieties
ÎImplementation 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
Rapid (Lispro, Aspart, Glulisine) Short (Regular)
Intermediate (NPH) Long (Detemir) Long (Glargine) 0 2 4 6
8 10 12 14 16 18 20 22 24 Hours a(er injec.on
Hours © American Diabetes Association. 3
Insulin level
