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Dr. Abhijit Chavan
Dec 12, 2019
Exact calculation for insulin requirement in new diabetic patients , any guidelines ?
Dr. d●●●●y g●●●a
For patients with type 2 diabetes, the initial dose of insulin (whether in addition to oral agents, in place of oral agents, or as initial treatment) is similar.The initial dose for NPH, detemir, or glargine is 0.2 units per kg (minimum 10 units) daily. The initial dose for insulin degludec is 10 units subcutaneously once daily. If FBG levels are very elevated (>250 mg/dL [13.9 mmol/L]), or if a p
atient is known to be very insulin resistant, initial doses can be higher. Subsequent modifications can be made according to daily measurement of FBG and every three month A1C values. Persistent fasting hyperglycemia — If the mean FBG is above target (typically 130 mg/dL [7.2 mmol/L]), an increase of 2 to 4 units in the basal insulin dose should be made periodically (approximately every three days) As patients approach the glycemic target, it may be helpful to check a mid-sleep blood glucose to rule out hypoglycemia (this can be done when the patient spontaneously wakes overnight). Persistent elevation in A1C with FBG in target range — For patients with persistently elevated glycated hemoglobin (A1C) levels who have fasting blood glucose (FBG) levels in the target range (80 to 130 mg/dL [4.4 to 7.2 mmol/L], or higher, depending on the individualized glycemic target), we advise the patient to check fingerstick capillary glucose levels fasting, pre-lunch, pre-dinner, and before bed while the insulin regimen is further adjusted. Prandial insulin may be started as a single injection before the largest meal of the day, but many strategies are possible Pre-meal insulin dosing: A typical starting dose is approximately 4 to 6 units . The dose can be increased by 2 to 3 units every three days until the postprandial blood glucose target is achieved. However, pre-mixed insulin is a reasonable option for patients with type 2 diabetes who are doing well on a stable, fixed ratio, particularly those who eat a larger breakfast and dinner and a smaller lunch. Use of automated insulin algorithms —one handheld device is under development that contains a glucose meter and uses an insulin algorithm to determine each insulin dose, based on the glucose readings. The software analyzes glucose patterns and adjusts the insulin dose to meet patient needs.
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Dec 13, 2019