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INITIATION OF INSULIN THERAPY FOR TYPE 2 DIABETES MELLITUS IN CHILDREN AND ADULTS 1 : A SIMPLIFIED APPROACH Targets A1 C
WORKSHEET Revised 10-20-05 Advancing to Intensive/Physiologic Basal: Bolus Insulin Therapy Note: “Analog” = Rapid Acting (Bolus) Analog insulin throughout this document. A. Conversion from once-daily insulin to intensive/physiologic insulin replacement: Oral therapy failure: Once-daily glargine was added to the oral regimen and titrated to 30 units per day. How do you add analog insulin if the patient reports the following SMBG values? 2-hr pp 2-hr pp 2-hr pp FPG Brkft Lunch Dinner Case 1 105 140 140 240 Case 2 105 140 190 240 Case 3 105 190 240 240 Case 1 a. Continue the oral agents (+ sulfonylurea) and 30 units glargine (or NPH) b. There are 2 approaches for adding analog 10 minutes before a meal: #1 Arbitrary start: 5 units Titrate: Add 2 units every 2 days to reach 2-hr pp goal #2 Carb-counting 1 unit/50 mg/dL over 2-hr pp goal PLUS 1 unit/15 grams carbohydrate Titrate: Add 1 unit/50 mg/dL >2-hr pp goal every 2 days Cases 2 and 3 As above, but add and titrate analog before each meal where the postprandial glucose is above goal. Also, see part D, below, for more information on how to optimize the use of analog insulin. Re-evaluate each week to be certain that about half of the total daily dose is basal and half is bolus insulin. B. Conversion from once-daily premix to intensive/physiologic insulin replacement: Oral therapy failure: Once-daily 70/30 premixed insulin was added and titrated to 30 units per day. The fasting glucose is at goal, but daytime control is poor. How do you convert to physiologic insulin therapy? a. Basal insulin dose: The first step in the conversion is based on the total dose of intermediate-acting insulin. In this case, the person is taking 21 units of NPH or aspart-protamine insulin (70% x 30 units=21 units). So, give 21 units basal glargine (use “unit-for-unit” conversion for once-daily intermediate regimens.) Remember, do not stop oral agents (+ sulfonylurea) at this time. b. Bolus insulin dose: There are several ways to start the analog. i. See Case 1, page 2 (Arbitrary start or Carb-counting) ii. Begin with the previous dose of fast-acting insulin, divide it before meals and titrate every 2 days. In this case, the person was using 30 units of 70/30 or about 9 units of fast-acting insulin (30% x 30 units=9 units). So give 3 units of analog before each meal and titrate every 2 days as per Case 1. (Page 3 of 6) H EALTH PLANS www.cfhp.com 49
Page 1 and 2: Community First Health Plans Qualit
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Page 5 and 6: Such information is released only t
Page 7 and 8: Non Voting • Martin Jimenez, Dire
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Page 35 and 36: The evaluation of breast disease is
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Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47: Publication # 45-11647 Targets* A1
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Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
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Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
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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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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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