Wiener Medizinische Wochenschrift

, Volume 161, Issue 11–12, pp 300–304

Insulin therapy

Main topic


Insulin therapy is a vital hormone replacement therapy in type 1 diabetes mellitus. In type 2 diabetes, insulin is indicated if glycaemic goals are not reached by oral antidiabetics, as well as for metabolic detoriation, co-morbidities, surgery, pregnancy or contradictions against oral antidiabetics. Insulin preparations are characterized by the onset of the insulin action, the peak profile and duration of action. Available are short acting, long-acting and premixed preparations of human insulin, and insulin analogues. The gold standard of insulin therapy in type 1 diabetes is functional insulin therapy with a basal-bolus insulin regimen and control and adaption of the therapy by the patient. Various insulin regimens are available for treating patients with type 2 diabetes, including basal insulin supported oral therapy, supplementary mealtime injection of short acting insulin or insulin analogues, conventional insulin therapy or a basal bolus procedure. The various insulin preparations and regimens make it possible to adapt the therapy according to the patient's individual need.


Insulin therapy Preparations and regimen 



Bei Typ-1-Diabetes stellt die Insulintherapie eine lebensnotwendige Hormonersatztherapie dar. Indikationen zur Insulintherapie bei Typ-2-Diabetes sind das Nicht-Erreichen der glykämischen Zielwerte unter Therapie mit oralen Antidiabetika, eine metabolische Entgleisung, Ko-Morbiditäten, Schwangerschaft und Kontraindikationen gegenüber oralen Antidiabetika. Zur Insulintherapie stehen kurz- und langwirksame Insuline und Insulinanaloga wie auch Mischinsuline zur Verfügung. Der Goldstandard in der Behandlung des Typ-1-Diabetes ist die funktionelle Insulintherapie mit der Verabreichung eines Basis- und kurzwirksamen prandialen Insulins und der Dosisanpassung durch den Patienten selbst. Für die Therapie des Typ-2-Diabetes stehen unterschiedliche Insulintherapieformen zur Verfügung, wie die Basis-Insulin unterstützte orale Therapie, die supplemetäre Insulintherapie mit der Gabe eines kurzwirksamen prandialen Insulins, die konventionelle Insulintherapie und die Basis-Bolus-Therapie. Die unterschiedlichen Insuline und Verabreichungsformen gestatten insbesondere für den Typ-2-Diabetiker eine Anpassung der Insulintherapie an die individuellen Bedürfnisse des Patienten.


Insulintherapie Präparate Formen 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. The Diabetes Control and Complications trial research group. Effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 329: 977–986, 1993CrossRefGoogle Scholar
  2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS33). Lancet, 352: 837–853, 1998CrossRefGoogle Scholar
  3. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 359: 1577–1589, 2008PubMedCrossRefGoogle Scholar
  4. American Diabetes Association. Clinical Practice Recommendations 2010. Diabetes Care, 34(Suppl. 1): S4–S10, 2010Google Scholar
  5. Mooradian AD, Bernbaum M, Albert SG. Narrative review: a rational approach to starting insulin therapy. Ann Intern Med, 145: 125–134, 2006PubMedGoogle Scholar
  6. Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev, 4: CD003287, 2004PubMedGoogle Scholar
  7. Heise T. Getting closer to physiologic insulin secretion. Clin Ther, 29(Suppl. D): 161–165, 2007CrossRefGoogle Scholar
  8. Bazzano LA, Lee LJ, Shi L, et al. Safety and efficacy of glargine compared with NPH insulin for the treatment of type 2 diabetes: a meta-analysis of randomized controlled trials. Diabet Med, 25: 924–932, 2008PubMedCrossRefGoogle Scholar
  9. Raslova K. An update on the treatment of type 1 and type 2 diabetes mellitus: focus on insulin detemir, a long acting human insulin analog. Vasc Health Risk Manag, 6: 399–410, 2010PubMedCrossRefGoogle Scholar
  10. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analoges versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev, 18: CD005613, 2007Google Scholar
  11. Mannucci E, Monaki M, Balzi D, et al. Doses of insulin and its analogue and cancer occurrence in insulin-treated type 2 diabetic patients. Diabetes Care, 33: 1997–2003, 2010PubMedCrossRefGoogle Scholar
  12. Rolla A. Pharmacokinetic and pharmacodynamic advantages of insulin analogues and premixed insulin analogues over human insulin: impact on efficacy and safety. Am J Med, 121: 9–19, 2008CrossRefGoogle Scholar
  13. Chapman TM, Noble S, Goa KL. Insulin aspart: a review of its use in the management of type 1 and type 2 diabetes mellitus. Drugs, 62: 1945–1981, 2002PubMedCrossRefGoogle Scholar
  14. Oiknine R, Bernbaum M, Mooradian AD. A critical appraisal of the role of insulin analogues in the management of diabetes mellitus. Drugs, 65: 325–340, 2005PubMedCrossRefGoogle Scholar
  15. Barlocco D. Insulin glulisine. Aventis Pharma. Curr Opin Invest Drugs, 4: 1240–1244, 2003Google Scholar
  16. Gerich GE. Insulin glargine: long-acting basal insulin analog for improved metabolic control. Curr Med Res Opin, 20: 31–37, 2005CrossRefGoogle Scholar
  17. Heinemann L, Sinha K, Weyer C, et al. Time-action profile of the soluble, fatty acid acylated long-acting insulin analogue NN304. Diabet Med, 16: 332–338, 1999PubMedCrossRefGoogle Scholar
  18. Tone A, Iseda I, Higuchi C, et al. Comparison of insulin detemir and insulin glargine on glycaemic variability in patients with type 1 and type 2 diabetes. Exp Clin Endocrinol Diabetes, 118: 320–324, 2010PubMedCrossRefGoogle Scholar
  19. Jensen MG, Hansen M, Brock B, et al. Differences between long-acting insulins for the treatment of type 2 diabetes. Expert Opin Pharmacother, 11: 2027–2035, 2010PubMedCrossRefGoogle Scholar
  20. Brunton S. Initiating insulin therapy in type 2 diabetes: benefits of insulin analogs and insulin pens. Diabetes Technol Ther, 10: 247–256, 2008PubMedCrossRefGoogle Scholar
  21. Masuda K, Aoki K, Kikuchi K, et al. Self-injection of insulin using appropriate supportive devices in handicapped subjects with diabetes. Diabetes Technol Ther, 12: 483–490, 2010PubMedCrossRefGoogle Scholar
  22. Bode BW. Insulin pump use in type 2 diabetes. Diabetes Technol Ther, 12(Suppl. 1): 17–21, 2010Google Scholar
  23. Goudswaard AN, Furlong NJ, Rutten GE, et al. Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus. Cochran Database Syst Rev, 18: CD003418, 2004Google Scholar
  24. Yki-Järvinen H, Kauppinen-Makelin R, Tiikkainen M, et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia, 49: 442–451, 2006PubMedCrossRefGoogle Scholar
  25. Holman RR, Farmer AJ, Davies MJ, et al.; 4-T Study Group. Three year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med, 361: 1736–1747, 2009PubMedCrossRefGoogle Scholar
  26. Hollander PA, Kushner P. Type 2 diabetes comorbidities and treatment challenges: rationale for DPP-4 inhibitors. Postgrad Med, 122: 71–80, 2010PubMedCrossRefGoogle Scholar
  27. Garber AJ. Premixed insulin analogues for the treatment of diabetes mellitus. Drugs, 66: 31–49, 2006PubMedCrossRefGoogle Scholar
  28. Wolffenbuttel BH, Klaff LJ, Bhushan R, et al. Initiating insulin therapy in elderly patients with type 2 diabetes: efficacy and safety of lispro mix 25 vs. basal insulin combined with oral glucose-lowering agents. Diabet Med, 26: 1147–1155, 2009PubMedCrossRefGoogle Scholar
  29. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Red Clin Pract, 28: 103–117, 1995CrossRefGoogle Scholar
  30. Weng J, Li Y, Xu W, et al. Effect of intensive therapy on beta-cell function and glycaemic controls in patients with newly diagnosed type 2 diabetes: a multicentre andomized parallel-group trial. Lancet, 371: 1753–1760, 2008PubMedCrossRefGoogle Scholar
  31. Clodi M, Fasching P, Hoppichler F, et al. Antidiabetische Therapie bei Typ 2 Diabetes. Wien Klin Wochenschr, 121(Suppl. 5): 13–17, 2009Google Scholar
  32. Lechleitner M, Roden M, Weitgasser R, et al. Insulintherapie bei Diabetes mellitus. Wien Klin Wochenschr, 121(Suppl. 5): 18–21, 2009Google Scholar
  33. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia, 52: 17–30, 2009PubMedCrossRefGoogle Scholar
  34. Schernthaner G, Barnett AH, Betteridge DJ, et al. Is the ADA/EASD algorithm for the management of type 2 diabetes (January 2009) based on evidence or opinion? A critical analysis. Diabetologia, 53: 1258–1269, 2010PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Landeskrankenhaus Hochzirl, Anna Dengel-HausZirlAustria
  2. 2.Krankenhaus der Barmherzigen BrüderSalzburgAustria
  3. 3.SIPCAN-Initiative für ein gesundes LebenSpecial Institute for Preventive Cardiology and NutritionSalzburgAustria

Personalised recommendations