Dr Yehuda Handelsman Discusses New Alternatives to Basal Insulin

Recent advances in insulin formulations and innovative drug classes have made it easier than ever to manage diabetic patients’ glucose levels, according to Yehuda Handelsman, MD, FACP, FACE, FNLA, medical director and principal investigator at the Metabolic Institute of America.

Transcript (slightly modified)

What strategy should be used when basal insulin is not enough when treating patients with diabetes?

One of the easiest ways to deal with getting control of the glucose is to keep increasing basal insulin, and when we get to a certain level, it won’t do much for the patients, and so we need also to assume that it’s not only the fasting sugar, which is primarily affected by basal insulin, but the sugar that goes up secondary to meals, occasionally secondary to certain activities and so on. There’s several ways to deal with it.

Traditionally we use short-acting insulin, and in the short-acting insulin we’ve got various formulations now. They’re getting more and more almost physiological in the way that we can administer them today. We can start giving it at the largest meal of the day, dinner let’s say, and then as time goes by and patients may need more we will increase the number of times to give it with every meal that they’re getting.

There are other medications now that often will help. They’re a new class of drugs called the GLP-1 inhibitors, also by injection, and they seem to have a very good effect on postprandial, that’s after-meal sugars, so we can start that first. Another class of drug called the SGLT-2 inhibitors, also the class DPP-4 inhibitors. All of those classes of drugs, the patients are not on them when they are on insulin, could be tried before we go to short-acting insulin. So we’ve got various options that we can use, and again get the patient to work with us on that to make sure that they get that better control, that often just basal insulin is not enough.