01 Insulin

DM2

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

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

Last updated 4 years ago