Background: Type 2 diabetes mellitus requires monitoring patients' glycemic control. Treatment must be escalated if glucose levels remain above the recommended goal in patients who are adherent to their current treatment. If glycosylated hemoglobin (HbA1c) levels remain unmet with maximum doses as recommended by the American Diabetes Association (ADA) after adding basal insulin, but fasting blood glucose is at goal, one to three injections daily of rapid-acting insulin are typically added to the treatment plan to be injected prior to meals while continuing all other antihyperglycemic medications.
Objective: To describe an effective method of intensifying insulin therapy based on patients' needs and abilities to self-manage their medications.
Methods: We retrospectively reviewed the case of a patient who was referred to the Endocrinology Specialty Clinic for diabetes management.
Results: Diabetes control was improved after intensifying insulin therapy by adding once-daily rapid-acting insulin injections.
Conclusions: Intensifying insulin therapy by adding one dose of rapid-acting insulin prior to meals can improve HbA1c to < 7% in patients on maximum doses of basal insulin whose fasting blood glucose is at goal but whose HbA1c is above goal.
Implications for nursing: Nurse practitioners must use current care guidelines supported by evidence-based literature to improve patients' outcomes. This case study supports ADA recommendations on early intensification of antihyperglycemic therapy in diabetic patients to decrease the risk of complications by achieving and maintaining HbA1c goals early.
Keywords: basal insulin therapy; basal-bolus insulin therapy; basal-plus insulin therapy; glycemic goals; type 2 diabetes mellitus.
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