Once all categories of antidiabetic drugs have been exhausted, a move onto insulin should be considered.

Commencing insulin therapy can be scary but many people find, once they are on it, that they are able to take better control of their blood glucose and experience fewer side effects compared to oral antidiabetic medicines. There are a number of insulin starting regimens, but most patients with type 2 diabetes will be started on an intermediate-acting isophane insulin once or twice a day in combination with their antidiabetic drugs. Weight gain and hypoglycaemia may be complications of insulin therapy but weight gain may be reduced if the insulin is given in combination with metformin.

Reflective exercise

A patient recently diagnosed with type 2 diabetes has been having issues with diet, exercise and the gastrointestinal side effects of taking metformin over the past three months. Consider the following:

• What sort of advice/support could you offer?
• What treatment options does the patient have?
• Who would you refer the patient to? Consider healthcare professionals, charities and local support networks.