A Comparison of Two Initial Dosing Formulas

The current recommended starting dose of basal insulin in type 2 diabetes is either a fixed dose, e.g. 10 U, or a weight-based formulas, 0.1-0.2 U/kg. The estimate of eventual titration dose to attempt to reach a fasting glucose goal is 0.49 U/kg. Those many weeks of dosage upward titration are required. The investigators propose to compare the current recommended weight based, 0.1 U/kg to a correction factor derived formula. Starting with an insulin tolerance test estimation of basal dose, one would arrive at the eventual titrated basal insulin dose in significantly less days than starting at a starting dose estimate of 0.1 U/kg. Further, there would be no significant increase in overall reported hypoglycemia.

Inclusion criteria

• Type 2 diabetes
• Age 18 years and above
• Concurrently on ± sulfonylureas ± thiazolidinedione ± DDP IV inhibitors ± metformin ± glinides
• A1c ≥ 7.0% but ≤ 10%
• Capable of self monitoring glucose ≥4/day
• Previously compliant with clinical recommendations
• Fasting blood glucose ≥ 150 mg/dl
• BMI ≤ 45 kg/m2

Exclusion criteria

• Urinary ketosis
• Currently or expected alteration in insulin sensitivity such as major surgery, infection, renal failure (creatinine >1.5 mg/dl), glucocorticoid treatment, recent (within 2 weeks) serious hypoglycaemic episode (requires assistant of another)
• Currently participating in another clinical trial
• Known or suspected allergy to insulin determir
• Using insulin
• Pregnancy or nursing or the intention of becoming pregnant or not using adequate
• Significant liver or heart failure.