In this fifth episode, Dr Tebelele and Dr Mashitisho explore the different insulin formulations, their pharmacological properties, and clinical applications in the management of Type 2 Diabetes Mellitus (T2DM). The discussion builds upon earlier episodes by delving deeper into how to select the most appropriate insulin type for each patient’s lifestyle, physiology, and treatment goals.

The episode provides an in-depth comparison between human insulins, NPH, and basal analogues such as glargine, detemir, and degludec. Dr Mashitisho explains how molecular modifications influence onset, duration, and stability, making certain formulations better suited for specific patient profiles. Practical advice on switching between insulin types, adjusting doses, and avoiding common errors reinforces the session’s clinical relevance for South African practitioners.

1. Differentiate between major insulin classes — rapid-acting, short-acting, intermediate, and long-acting basal analogues.
2. Describe the pharmacokinetic and pharmacodynamic characteristics of common basal insulins.
3. Select an appropriate insulin type based on patient needs, cost, comorbidities, and adherence factors.
4. Recognise when and how to safely switch between insulin formulations.
5. Identify strategies to minimise side effects such as hypoglycaemia and weight gain.

• Apply evidence-based reasoning to select the most suitable insulin for individual patients.
• Adjust or transition insulin regimens safely, using pharmacological principles.
• Educate patients about the differences between insulin options, improving adherence and outcomes.
• Reduce insulin-related complications through appropriate monitoring and dose adjustment.
• Integrate cost, availability, and patient preference into shared decision-making for long-term diabetes management.

• Understanding insulin families: Human vs analogue insulins, including how amino-acid alterations modify action profiles.
• Basal insulin comparison: Glargine (flat, 24-hour action), Detemir (dose-dependent duration), and Degludec (ultra-long stability).
• Clinical implications: Matching insulin type to patient lifestyle—shift workers, elderly, those with hypoglycaemia risk, or variable meal patterns.
• Transitioning regimens: Safely switching from NPH to analogues to improve stability and adherence.
• Practical pearls: Refrigeration, injection timing, and rotating sites to ensure consistent absorption.
• Patient engagement: Simplifying the “science of insulin” for improved confidence and compliance.
• Local context: Balancing efficacy, cost, and accessibility in the South African healthcare landscape.