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Following diet and exercise, oral antidiabetic drugs (OADs), and incretin therapies, many patients require insulin, but initiation is often delayed until complications develop.<\/jats:p><jats:p><jats:bold>Data sources:<\/jats:bold> Published guidelines for the management of T2D, primary and review articles, and Food and Drug Administration (FDA) prescribing information.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The diabetes nurse practitioner should encourage patients to initiate insulin when appropriate; patients need to know that this represents a natural step in treatment, not a personal failing. Initiation often occurs when OADs no longer confer adequate glycemic control. Treatment regimens available include once\u2010daily basal insulin, sometimes with addition of prandial insulin, or premix\/biphasic insulin. Insulin analogs confer less risk of hypoglycemia and weight gain, and greater dosing flexibility compared with conventional insulins. Insulin efficacy may be enhanced by continuing metformin and\/or incretin therapies, while discontinuing other drugs as appropriate.<\/jats:p><jats:p><jats:bold>Implications for practice:<\/jats:bold> The well\u2010versed diabetes nurse practitioner assists the patient in selecting the most appropriate option for his\/her specific needs. It is essential to help patients overcome barriers, including fears of injection pain, public embarrassment, and hypoglycemia risk.<\/jats:p>","DOI":"10.1111\/j.1745-7599.2012.00721.x","type":"journal-article","created":{"date-parts":[[2012,5,8]],"date-time":"2012-05-08T07:30:18Z","timestamp":1336462218000},"page":"249-259","source":"Crossref","is-referenced-by-count":10,"title":["Insulin initiation in type 2 diabetes: What are the treatment regimen options and how can we best help patients feel empowered?"],"prefix":"10.1111","volume":"24","author":[{"given":"Geralyn R.","family":"Spollett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,5,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-S011"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.11.019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)06032-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2009.01060.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02546-0"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051400"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.13.9.923"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-409X(98)00079-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-008-9419-1"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/en.2004-0015"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60659-0"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-154-2-201101180-00300"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-2117"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-002-0931-5"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200262130-00014"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2010.01317.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.1.220"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.6.1282"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145721706289226"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)12131-1"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2004.04.013"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.5.1092"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.17.2254"},{"key":"e_1_2_8_25_1","unstructured":"Diabetes Attitudes Wishes and Needs (DAWN) study. 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