Choosing injectable therapy: the metabolic fulcrum

This clinical decision making hypothesis utilizes the metabolic fulcrum based approach to classify persons with diabetes into three categories: predominantly catabolic,eubolic,and predominantly [maladaptive] anabolic. this systematic arrangement helps define choice of injectable therapy in type 2 diabetes mellitus. patients with predominant catabolism,may respond better to intensive insulin therapy. dual action insulin,including premixed insulin and i deg asp (insulin degludec aspart),may be an acceptable alternative. uncomplicated,eumetabolic patients with type 2 diabetes may use any of the various drugs available. patients classified as having maladaptive anabolism may benefit from a glp1ra. if this does not suffice,a glp1ra + basal insulin combination may be effective. © 2016,pakistan medical association. all rights reserved.