1 / 7

T1DM: Insulin Initiation

T1DM: Insulin Initiation. Recommended to start conservatively at approximately 0.5 units/kg/day ( Range: 0.4-1.0 units/kg/day). Calculate TDD. ~50%. ~50%. Total Basal Insulin Dose. Total Prandial/Basal Dose. Lunch. Dinner. Breakfast. TDD : Total Daily Dose (insulin).

wblevins
Download Presentation

T1DM: Insulin Initiation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. T1DM: Insulin Initiation • Recommended to start conservatively at approximately 0.5 units/kg/day (Range: 0.4-1.0 units/kg/day) Calculate TDD ~50% ~50% Total Basal Insulin Dose Total Prandial/Basal Dose Lunch Dinner Breakfast TDD: Total Daily Dose (insulin) American Diabetes Association. Medical Management of Type 1 Diabetes, 6th Ed 2012. Walsh J et al. Using Insulin. 2003.

  2. T1DM: Insulin Initiation Example • What would be a reasonable initial regimen for a patient newly diagnosed with T1DM that weighs 80 Kg? • Calculate TDD based on weight in Kg: • 80 Kg x 0.5 units/kg/day = 40 units/day (TDD) • Determine the amount of insulin to be given as basal and prandial insulin, respectively: • 40 units/day / 2 = 20 units basal insulin • 20 units prandial insulin • Counsel patient to monitor blood glucose (BG) levels and titrate insulin products per individual needs. • Once the insulin is started we aren’t done! The insulin will need to be actively titrated to meet fasting and postprandial targets/goals.

  3. T1DM: Insulin Initiation ExampleApplying Dosing Instructions • The patient’s insulin has been titrated per individualized needs. His insulin prescription is now as follows: • Insulin glargine U-100 (Lantus) 24 units SubQ QHS • Insulin lispro U-100 (Humalog) 1:10 + 1/50 > 100 • Let’s break this down: • Insulin glargine = 24 units at bedtime in a single injection • Insulin lispro = • 1 unit per 10 grams of carbohydrate (Insulin:Carb Ratio) • 1 additional unit added for every 50 mg/dL the patients pre-meal blood glucose is above 100 mg/dL (Sensitivity/Correction Factor) We will practice use and application of Insulin:Carb Ratios and Correction Factors in Class

  4. Pharmacokinetic Profile of Currently Available Single Insulin Products Rapid (aspart, lispro, glulisine, inhaled human insulin) Short (regular U-100) Mixed short/intermediate (regular U-500) Intermediate (NPH) Plasma Insulin Levels Long (detemir) Ultra-long (degludec) Long (U-100 glargine) (glargine U-300) Ultra-long 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 Time (hr) Hirsch IB. N Engl J Med. 2005; 352:174-83. Flood TM. J Fam Pract. 2007; 56(suppl 1):S1-S12. Becker RH et al. Diabetes Care. 2015; 38:637-43.

  5. Insulin PK/PD Comparison* *Patient-specific onset, peak, and duration may vary from times listed in table. †Insulin aspart is available in 2 formulations: Novolog and Fiasp. Fiasp has a faster relative onset of action. Hirsch IB. N Engl J Med. 2005; 352:174-83; Individual product prescribing information.

  6. Premixed insulin analogs Aspart 70/30 Insulin Effect B L S HS

  7. Select Premixed Insulin Products The first number in the mix designation (70/30, 75/25, etc.) is the basal fraction & the second number is the prandial fraction.

More Related