> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/03-residency/01-insulin.md).

# 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

![](https://f001.backblazeb2.com/file/wikiFiles/insulin.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/insulin2.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/insulin3.jpg)

## A1C to Glucose

* For each 1 point on A1C, BG goes up/down by 30
* 8 = 180
* 9 = 210