Temporary insulin therapy in type 2 diabetes

René Rodríguez-Gutiérrez, MD, is a professor of medicine at the Autonomous University of Nuevo León in Mexico and associate professor at Mayo Clinic, USA. His research interests include insulin resistance and glycemic control in type 2 diabetes.

What are the indications for temporary insulin therapy in patients with type 2 diabetes?

René Rodríguez-Gutiérrez, MD: Most patients can be discharged with oral medications, but there are these special cases in which we truly use—and probably it is better just to discharge them with—some kind of insulin. And the caveat for this range of patients is that usually those patients come with very uncontrolled diabetes prior to DKA or diabetic hyperglycemic hyperosmolar state (HHS), or glycated hemoglobin (HbA_1c) >10% to 12%. They clearly need some help with a basal insulin at the beginning. I’ll say, at least in type 2 diabetes, it’s very unusual for us to discharge a patient with the basal bolus, but it’s definitely important that patients with very uncontrolled diabetes, for instance, can be discharged with a basal [insulin] plus antidiabetic medicines.