01 Insulin

DM2

Types of insulin

  • short acting: regular; onset 30 min - 1 hour

  • rapid acting: NPH, lispro; onset 15 - 30 min

  • Lantus (Levemir): given sometimes once and sometimes twice a day

  • NPH: 12 hours, give 2x/day

  • Humulin-R: 6 hours, give with meals, only use if can't afford others

  • U-500: 500 units of concentrated insulin, use when using more than 300 u/day. Use like humulin R but like a basal. 60% in morening, 40% at night or 40-30-30

  • 70/30: mixed

    • 70% basal (NPH), 30% short acting

    • dose like NPH, but right before meal

    • only use if struggling with injections

  • SSI: check glucose, then give insulin based on sugar and food given

Principles

  • start with metformin, then go to basal insulin (long acting), then add meal time insulin (short acting)

  • start insulin if using 3 or more agents or if A1C > 10%

  • start with basal insulin to reach fasting goal of 80-130. Goal: go to bed and wake up same BG. Go to bed, less than 150. 2 hours after meal less than 180

  • once fasting is under controlled, recheck A1C in 3 months. If high, check after meal glucose

  • start meal time insulin once bed time and morning BG are same

  • Start with biggest meal of the day, then go up to 3x/day if needed

  • 10% basal dose = meal time. E.g. 60 units basal insulin, 6 x 3 = 18 units / meal

  • 1/2 basal. E.g. 60 units basal, 30 units total / 3 = 10 units / meal

  • Can use GLP in place of meal time insulin

Check Insulin

  • 2 hours after meal: post prandial less than 180. Fasting 80-130

DM 1

  • start with basal bolus insulin

  • weight based dosing 0.1-0.4 u/kg

    • spit in 1/2

    • 50% basal

    • 50% bolus

  • count carbs

  • give pumps if uncontrolled

Chart

A1C to Glucose

  • For each 1 point on A1C, BG goes up/down by 30

  • 8 = 180

  • 9 = 210

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