Version July 2025
ANSWER —
Incorrect.
The patient talks to his older brother, who also has type 2 diabetes. His brother tells him that he takes a mixture of a "fast" and a "slow" insulin. The patient asks that his medical records be sent to his brother's clinician.
The approach that you recommended, with lispro insulin before supper and glargine insulin at bedtime, was reasonable and well-tailored to the needs of this patient. However, this is not the only possible approach. It is often helpful to accommodate to the patient's lifestyle and preferences if possible.
The important decision at this point is to start insulin. This can be done in several different ways (see "Interactive diabetes case 2: Switching from oral agents to insulin in type 2 diabetes"). While mixed insulin preparations do not allow you to vary the short-acting or very short-acting pre-meal insulin dose and the intermediate-acting basal insulin dose separately, they are often effective. The mixture of a very short-acting insulin and an intermediate-acting insulin given before supper in this patient is appropriate to the patient's lifestyle, which includes a large meal at supper.
Return to the previous choice to try again. (See "Interactive diabetes case 14: A 41-year-old patient with type 2 diabetes and hypertriglyceridemia – A3".)
