Insulinothérapie dans le diabète de type 2

The natural processus of type 2 diabetes is characterised by a progressive decrease in insulin secretion. It is why at the present time, in order to preserve insulin secretion, insulin therapy early takes place in type 2 diabetic therapeutic management. But, if a good glycemic control has been shown to prevent microvascular complication, this protective effect on macrovascular complications is more controversial. Furthermore, while hypoglycemia is rare, the main problem with insulin in type 2 diabetes is weight gain. When tablets-relying therapy is no more efficient, the best insulin therapeutic protocol, in term of metabolic performance, limited weight gain, and patient agreement, consists in a Bed-time NPH or a long lasting insulin analog injection, with a normal fasting glycemia as objective. The next step consists in dividing insulin therapy in several rapid analog insulin injections. Whatever the insulin protocol used, metformine association seems to be beneficial.