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534 Initiation & Intensification of Insulin Therapy in T2DM

O.P. HYPERGLYCEMIA

INDIAN INSULIN GUIDELINES –

INITIATING INSULIN

Start insulin

At diagnosis OAD failure
If: If:
• FPG >250 mg/dL • FPG >150 mg/dL
• PPG >300 mg/dL • PPG/RBG >200 mg/dL
• HbA >9% • HbA 1c >8.5%
1c
Or if patient has: Despite receiving optimal dose of
• Systemic infection two or three OADs
• Sepsis
• Acute myocardial
infarction Other indications if there is systemic infection,
• Unstable angina sepsis, acute MI, unstable angina, DKA/HONK,
• Diabetic ketoacidosis pregnancy, diabetic kidney disease
• Pregnancy DKA, diabetic ketoacidosis; FPG, fasting plasma glucose; HONK, hyperosmolar nonketotic
• Perioperative care coma; MI, myocardial infarction; OAD, oral antidiabetic drug; PPG, postprandial plasma
glucose; RBS, random blood sugar
INCG. National guidelines on initiation and intensification of insulin 19
therapy with premixed insulin analogues. 2013. INCG. J Assoc
Physicians India 2009:57(Suppl. 1):42–6

Indian Insulin Guidelines – Initiating and

Optimising Insulin Analogues

First line Metformin

HbA 1c >7.0 Metformin + HbA 1c >7.0 Metformin + premix
OAD/GLP-1
to ≤7.5 after 3 insulin (30) once/
agonist months twice daily

HbA 1c >7.5 Metformin + premix insulin (30) once daily
to ≤8.5 Metformin + premix insulin (30) twice daily
HbA 1c >8.5

HbA 1c >7.0 Titrate premix insulin (30) once/twice daily to
FPG >100 achieve <100 mg/dL
mg/dL

INCG. National guidelines on initiation
and intensification of insulin therapy 20
with premixed insulin analogues. 2013.
INCG. J Assoc Physicians India

GCDC 2017