The effects of diabetes mellitus include long-term damage, dysfunction and failure of various organs

Combination of insulin+ oral anti-diabetic agents (BIDS) has been shown to improve glycaemic control in those not achieving target despite maximal combination oral anti-diabetic agents.

Combining insulin and the following oral anti-diabetic agents has been shown to be effective in people with type 2 diabetes:

• Biguanide (metformin)
• Insulin secretagogues (sulphonylureas)
• Insulin sensitizers (TZDs)(the combination of a TZD plus insulin is not an approved indication)
• α-glucosidase inhibitor (acarbose)

Insulin dose can be increased until target FPG is achieved.

In elderly non-obese patients, short acting insulin secretagogues can be started but long acting Sulphonylureas are to be avoided. Renal function should be monitored.

• In elderly non-obese patients, short acting insulin secretagogues can be started but long acting Sulphonylureas are to be avoided. Renal function should be monitored.

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