Ján Čulák
Diabetes mellitus (DM) is a chronic progressive disease associated with the development of specific microvascular as well as macrovascular organ complications. Type 2 diabetes mellitus, a most frequent type of DM, is a heterogeneous syndrome of complex etiopathogenesis that is characterized by a hyperglycemia due to a disturbance of the insulin secretion and of the insulin effects. The course of the disease is highly individual, however, after good response to oral agents (OAD) in the initial stage of treatment, in most cases, we will not avoid the need of initiating the insulin therapy due to a progressive decrease in the endogenous insulin secretion. The majority of patients that are not satisfactorily controlled with OAD may benefit from early initiation of the insulin therapy, which in practice has been still lagging behind the recommendations of professional societies. The causes for such situation are multiple, consisting of barriers on the both sides - the patient and the physician, lack of time, financial costs of treatment, fear of complications - especially hypoglycaemia, but also the obstacles in the form of existing indication restrictions applicable to the recent insulin products. The cases presented in this publication document the possibility for a simple and efficient initiation of the insulin therapy by using the basal insulin analogue – the insulin glargine in a combination with oral antidiabetic agents(5,9).