Dosing Starting dose 03 to 05 unitskgd average insulin doses 06 to 08 unitskgd

Dosing starting dose 03 to 05 unitskgd average

This preview shows page 3 - 5 out of 7 pages.

Dosing Starting dose (0.3 to 0.5 units/kg/d), average insulin doses 0.6 to 0.8 units/kg/d; Obesity: 100IU/d BID dosing for IAI & SAI (2/3 of dosing in the morning, 1/3 of dosing in evening) BID dosing for Lantus, start at bedtime (50%), the remaining 50% with SAI before meals Type 2: LAI (0.1 IU/kg/d) initiated with oral agent Rational Drug selection A1C level: 7% desirable for most DM patients For pt w/ retinopathy & neuropathy, premixed insulin recommended Switching NPH to glargine, to avoid hypoglycemia, initial dose of insulin glargine reduced by 20% ; total daily dose of glargine between 2 and 100 units. Type 2 DM: unable to control with oral agents & have postprandial hyperglycemia RAI; Fasting hyperglycemia: bedtime NPH added ; overall poor control intensive insulin therapy or split-mix regimen (once or twice daily injection of either IAI or LAI) o Premixed insulin analogues: better at lowring Hb A1c and preprandial blood glucose— high risk for hypoglycemia o Premixed insulin analogues & new premixed insulin: less weight gain except for metformin and gliptins o LAI analogues: more effective than premixed in lowering fasting blood glucose, o Newer premixed insulin: better lowering Hb A1c & postprandial glucose than LAI o Newer insulin: more expensive Monitorin g Goal of therapy for both types are preprandial BG level 70-130 mg/dL; postprandial 180, bedtime 100-140 mg/dL; Hb A1c 7% (1% change equals BG 30 mg/dL and average bg level over period of 90-120 days) Type 1 needs quarterly; type 2 every 6 months; Signs of complication o Acute complications: DKA in patients with type 1 and hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) in patients with type 2 o Chronic complications: (Most common) nephropathy, retinopathy, peripheral and GI neuropathies, hypertension, cardiovascular disease, and dyslipidemia, wt gain Educatio n No more than two alcoholic beverages per day for men, one per day for women, plan for regular meal Oral agents Type 2 four primary alternations in glucose metabolism: (1) insufficient production of endogenous insulin by the beta cells of the pancreas, (2) tissue insensitivity to insulin, (3) impaired response of the beta cells to BG levels, and (4) excessive production of glucose by the liver secondary to increased glucagon levels. Beta cell responsiveness to glucose stimulus diminishes & hyperglycemia prevails Adipose tissue no taking up glucose in response to insulin, causing obesity
Image of page 3
Biguanides Metformin (Glucophage) first line therapy in adults & children age of 10+ Initially monotherapy, if not effective, combination therapy with other class agents or insulin Commonly used in pre-diabetes or glucose intolerance Sulfonylureas Glipizide (Glucotrol), glyburide (Diabeta), Glimepiride (Amaryl) True oral hypoglycemic Use for patient w/ endogenous insulin secretion Risk for hypoglycemia Should be used in combination therapy MOA Increase peripheral glucose uptake & utilization, decrease hepatic glucose production & intestinal glucose absorption No stimulation of insulin from pancreatic beta cell & no cause of hypoglycemia &
Image of page 4
Image of page 5

You've reached the end of your free preview.

Want to read all 7 pages?

  • Spring '14
  • Henrikson,J
  • Hypoglycemia

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask You can ask ( soon) You can ask (will expire )
Answers in as fast as 15 minutes