Good question! Main Problem is: there are almost no data to answer this question. The 4T Trial tried to answer some of those questions. Please see the publications attached. After one year prandial Insulin achieved the same glycaemic control as biphasic Insulin, but had the highest rate of hypoglycaemia. Basal only had the lowest risk for hypoglycaemia (and weight gain), but glycaemic control was somewhat higher. After three years (and planned intsification) differences are less, most patients end up with multiple daily injections.

The second paper! TP

Indeed, this scheme with prandial insulin only is not generally acepted. Patients needing insulin, usually need about 40% basal insulin and about 60% prandial insulin.

Theoretically, this scheme is possible, in case someone have high postprandial blood glucose levels and 'normal' basal and pre-prandial glucose levels and that person requires insulin. The situation is vary rare but not impossible.

The only time I have seen it used is with hyperglycaemia as a result of initiation of steroids or in palliative care

Please see

Chlup R, Vaverková H, Bartek J (1997) Complementary insulin therapy improves blood glucose and serum lipid parameters in type 2 (non-insulin-dependent) diabetic pa¬tients. I. Effects on blood glucose con¬trol. Exp Clin Endocrinol Diabetes 105 (Suppl 2): 70-73.

Vaverková H, Chlup R, Ficker L, Novotný D, Bartek J (1997) Comple¬men¬tary insu¬lin the¬ra¬py improves blood glucose and serum lipid para¬meters in type 2 (non-¬insulin-dependent) diabetic patients : II. Effects on serum lipids, lipoproteins and apoproteins. Exp Clin Endo¬crinol Diabe¬tes 105 (Suppl 2): 74-77

Chlup R, Vaverková H, Bartek J (2000) Long-Term Benefits of Comple¬mentary In¬su¬lin Therapy on Body Mass and Hemo¬globin A1c in Obese Type 2 Diabetic Pa¬tients. Dia¬be¬tes Research and Clinical Practice 50 (Suppl 1): S66-S67 (Abstract)

Chlup R, Zapletalová J, Seckar P, Malá E, Doubravová B, Táncosová S, Chlupová L, Pukowietz L, Zatloukal P. Benefits of complementary therapy with insulin aspart versus human regular insulin in persons with type 2 diabetes mellitus. Diabetes Technol Ther. 2007; 9(3):223-31.

Best regards Rudolf Chlup

Prandial insulin has certainly been used as an alternative to basal insulin or premixed insulin when initiating insulin therapy in type 2 patients. There have been a few trials comparing the 3 regimens. It is apparent that all three have a very similar effect on HbA1c reduction and basal glucose levels, prandial insulin has a significantly better reduction in postprandial glucose levels as might be expected, BUT using prandial insulin results in a much higher incidence of hypoglycaemia. I suggest you look up the APPOLO Trial (Bretzel, Owens et al Lancet 2008;371:1073-84) and also the paper by Holman RR et al on this (Holman RR et al. N Engl J Med 2009;361:1736-1747 ). These put the whole question very much in perspective.