Full Clinical Guidelines - Community First Health Plans.

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INSULIN ALGORITHM FOR TYPE 1 DIABETES MELLITUS 1 IN CHILDREN AND ADULTS ABBREVIATIONS: BASAL: Glargine or Detemir BOLUS (Prandial): Reg: Regular Insulin (peak action 3-4 hrs) RAI: Rapid Acting Insulin = Aspart, Glulisine, or Lispro (peak action 1-1 ½ hrs) PPG: Post-Prandial Glucose SMBG: Self-monitored blood glucose 2 TDI: Total daily insulin dosage in units Targets A1c < 6.5% Fasting SMBG 2
Publication # 45-11647 Targets* A1 C 8.5% 0.5 units/kg/day, take 80% of total NPH dosage as glargine [basal]; bolus dose=80% of glargine dose divided tid) Multi-dose Insulin Therapy (MDI) 10 -2 shots Split mix NPH + Short-acting insulin (SAI) (vial) (2:1 ratio AM, 1:1 ratio PM; or SAI sliding scale 7 ) or premix 70/30; 75/25 or 50/50 (pen/vial) -3 shots (especially if nocturnal hypoglycemia) SAI: ACB and ACS sliding scale 7 (pen/vial) + NPH: ACB and HS (pen/vial) or LAI: q daily (pen/vial) Starting dose 8 : 0.3–0.5 units/kg/day (or if current dose >0.5 units/kg/day, take 80% of QDI dosage) divided 2/3 as NPH/LAI; 1/3 as SAI; titrate to achieve glycemic targets Follow A1 C every 3–6 months and Adjust Regimen to Maintain Glycemic Targets (Insulin Requirement May Decrease as A1 C improves) ACS: Before supper FPG: Fasting plasma glucose HS: Bedtime LAI: Long-acting insulin = Glargine PCP: Primary care provider PPG: Postprandial plasma glucose SAI: Short-acting insulin = Regular (peak action 3-4 hrs); Lispro or Aspart (peak action 1 ½ hr) SMBG: Self-monitored blood glucose SQ: Subcutaneous TDI: Total daily insulin in units Pramlintide 10,12 Consider as adjunct therapy to insulin in patients unable to stabilize postprandial glucose. Footnotes 1 See Glycemic Control Algorithm for Type 2 Diabetes Mellitus in Children and Adults 2 Consider simultaneous combination oral agent therapy 3 Combining metformin with insulin therapy has been shown to result in less weight gain and better glycemic control with lower insulin requirements 4 Continue combination oral agent therapy + sulfonylurea 5 Continue metformin (+ 3 rd oral agent); probably discontinue sulfonylurea 6 PCP may decide to “ease” patient with poor beta-cell reserve into insulin therapy initially with QDI See web site (http://www.texasdiabetescouncil.org) for latest version and disclaimer. See reverse side for more information. (Page 1 of 6) 7 ~1-2 units for every 50 mg/dL above target SMBG; Regular insulin to be given 30-60 minutes AC meal 8 Dosages may differ in children and adolescents; consider referral to pediatric endocrinologist/comprehensive diabetes specialty team 9 Go lower and slower for thin/elderly/complicated patients 10 Consider referral to pediatric/adult endocrinologist/diabetes specialty team (option— insulin pump, Pramlintide) 11 Typical “carb” bolus = 1 unit SAI covers 500/TDI x g carbohydrates from meal (~ 10-15 g); strongly recommend referral to Registered/Licensed Dietitian or Certified Diabetes Educator with experience in diabetes nutrition counseling (see Worksheet D.) (Page 1 of 6) 9.4 Insulin Algorithm Type 2 DM in Children and Adults H EALTH PLANS www.cfhp.com 47
Page 1 and 2: Community First Health Plans Qualit
Page 3 and 4: 10.5 ATP III Classification of Chol
Page 5 and 6: Such information is released only t
Page 7 and 8: Non Voting • Martin Jimenez, Dire
Page 9 and 10: The purpose of these guidelines is
Page 11 and 12: Table 1. Adult Preventive Services
Page 13 and 14: Recommended Adult Immunization Sche
Page 15 and 16: Footnotes — Recommended Adult Imm
Page 17 and 18: CFHP has adopted the National Asthm
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Page 21 and 22: Managing Asthma Long Term 41 FIGURE
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Page 29 and 30: II. Some hyperactive-impulsive or i
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Page 33 and 34: Criteria Requirements 33. Release o
Page 35 and 36: The evaluation of breast disease is
Page 37 and 38: Prevent Child Texas, a non-profit o
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Page 41 and 42: possible), a careful, complete, and
Page 43 and 44: Examination/Test Oral / Dental Insp
Page 45: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
Page 51 and 52: D. Optimizing analog insulin use Re
Page 53 and 54: Publication # 45-11266 Age 126 mg/d
Page 55 and 56: Hypertension Algorithm for Diabetes
Page 57 and 58: Lipid Algorithm For Type 1 and Type
Page 59 and 60: References: Revised 1-24-08 • Col
Page 61 and 62: WEIGHT LOSS ALGORITHM FOR OVERWEIGH
Page 63 and 64: Publication #45-11825 Screening 1 :
Page 65 and 66: Publication #45-12000 DIABETIC FOOT
Page 67 and 68: DIABETIC FOOT CARE/REFERRAL ALGORIT
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Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
Page 75 and 76: Revised 10-25-07 Publication #: 45-
Page 77 and 78: Revised 2-21-08 Publication #: E45-
Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
Page 81 and 82: Orders for Adults with DKA and Hype
Page 83 and 84: D i a b e t e s t r e a t m e n t a
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Page 95 and 96: 11.3 Treatment of Hypertension H EA
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ALGORITHM FOR TREATMENT OF MAJOR DE
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CFHP has established guidelines for
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A. Documentation ______ B. Continui
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CFHP PCP MEDICAL RECORD REVIEW TOOL
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13.3 Specialist Medical Record Docu
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13.4 Specialist Medical Record Revi
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Risk Factors for Osteoporosis Fract
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It is well documented that obesity
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CLASSIFICATION OF OVERWEIGHT AND OB
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16.1.1 Preventive Pediatric Health
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H EALTH PLANS www.cfhp.com 117
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TEXAS MEDICAID PROVIDER PROCEDURES
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CHILDREN’S SERVICES HANDBOOK P h
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CHILDREN’S SERVICES HANDBOOK P R
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H EALTH PLANS www.cfhp.com 139
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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