American Diabetes Association, ADA (2009)
The following two images are from the above ADA consensus article below.
Algorithm for the metabolic management of type 2 diabetes
Algorithm for Initiation and adjustment of insulin regimens.
Medical Management of Hyperglycemia 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
The AAFP (2011)
“Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications.”
**The following uptodate.com article uses a version of the ADA algorithms above.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606813
2. Am Fam Physician. 2011 Jul 15;84(2):183-190.
3. http://www.uptodate.com/contents/insulin-therapy-in-type-2-diabetes-mellitus (this article uses the ADA algorithms above)
4. http://www.medscape.org/viewarticle/567952