An effective approach for narrow control of blood glucose once other combinations fail or are unwanted for other reasons is the use of evening administration of a long-acting insulin and an insulinotropic agent during the day. The evening dose of insulin should be titrated to achieve near normoglycemic blood glucose levels, while the insulinotropic agent improves postprandial blood glucose control during the daytime (34). Remarkably, a fair control may be achieved in some patients with type 2 diabetes, even when evening doses of 40 or more units of insulin are required. This scheme exploits the endogenous capacity for regulation of blood glucose still present with advanced type 2 diabetes, and may be tried before starting a multiple injection plan. However, this combination also is prone to cause substantial increases in body weight.
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