![]() Patients with newly diagnosed diabetes, those who are new to insulin therapy, and those with educational deficits should be referred to an outpatient diabetes educator for more comprehensive education. This includes the safe administration of insulin and medications, basic understanding of meal planning, and recognition and treatment of hypoglycemia. ![]() Insulin detemir is quickly gaining data and provides an additional option for basal coverage. Regular insulin, insulin aspart, insulin lispro, and NPH have the most human pregnancy data. With decreasing lengths of stay, it is only possible to provide “survival skills” education in the hospital. Insulin therapy remains the standard of care for type 1 diabetes, type 2 diabetes, and uncontrolled GDM during pregnancy. Patients who do not have prescription coverage will probably need to use generic oral agents and human insulin (NPH and regular) individually or premixed whenever possible. It is necessary to assess the patient's daily schedule, meal plan, insulin self-administration ability, and financial resources. For many patients with type 2 diabetes, once-daily basal insulin in combination with oral agents or twice-daily premixed insulin may be adequate. Although the use of a basal/bolus regimen is advocated in the hospital for flexibility, this regimen may not be feasible or necessary in the outpatient setting. ![]() For patients new to insulin therapy, it is important to begin education as soon as possible.
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