The Many Faces of Type 2 Diabetes

Objective: This report illustrates the treatment progression of a patient with rapidly decompensating type 2 diabetes. Methods: The patient had to transition to insulin therapy within 2 years of her initial diagnosis, following only a brief period of glycemic control with diet management, weight loss, and oral agents. This relatively rapid progression to insulin requirement is occasionally seen in adults with typical type 2 diabetes that may classify as a number of different subtypes of diabetes. Results: The case presented demonstrates how a simple stepwise approach to dose titration with basal insulin helped a patient with severe depletion of endogenous insulin achieve initial glycemic control, and how the addition of prandial insulin helped control her mealtime glycemic excursions. Conclusion: The use of basal-prandial insulin therapy is an effective option for patients with rapidly decompensating type 2 diabetes to achieve their glycemic goals without delays and to minimize associated morbidities.