Introduction

There is a good chance your practice is managing an ever-increasing number of people with diabetes. Insulin therapy is a medical necessity for all people with type 1 diabetes (T1D) and a useful treatment option for individuals with type 2 diabetes (T2D) who are unable to reach individualized glycemic targets with non-insulin glucose-lowering therapies. Understanding insulin products currently available on the market and current recommendations for use is vital to your practice and the people with diabetes under your care. Insulin’s ability to lower glucose is unparalleled. Insulin both increases glucose uptake by tissues (muscle and adipose) and suppresses hepatic glucose release. The primary safety concern and limitation to insulin use is treatment-emergent hypoglycemia. In addition, insulin therapy can contribute to weight gain, a negative effect for people with T1D as well as for those with T2D who are often already struggling with overweight or obesity. In this handbook, you will find information on the many common questions and challenges involved in managing people with insulin—from choosing the best insulin regimen to meet individualized needs and preferences, to addressing reluctance to starting insulin therapy, to minimizing and/or preventing insulin-associated weight gain and hypoglycemia. As is true in the general management of diabetes, insulin therapy must be individualized to the needs and priorities of the person with diabetes, with no single insulin regimen or delivery device appropriate for all people with diabetes. Following recommended approaches to initiating and titrating insulin therapy in consideration of individualized treatment goals and based on glucose monitoring data will help you guide the person with diabetes to meet their management goals while also minimizing associated risks. The American Diabetes Association has published this sixth edition of Practical Insulin: A Handbook for Prescribing Providers in the hope that it will assist you as a clinical reference in your efforts to initiate and titrate insulin therapy to optimize outcomes for the people with T1D and T2D that you care for.