InsulinTherapy - MEMS

Insulin regimens and frequency of injections per dayNo. of injectionsper day12345Insulin regimenBASALBASALPREMIXED ODBASALPREMIXED BDBASAL-PLUS (1)BASAL-PLUS (2)PRANDIALPREMIXED TDSPREMIXED-PLUSPREMIXED-PLUSBASAL-BOLUSBASAL-BOLUSType of insulin and timingIntermediate acting (NPH) insulin pre-bedLong-acting analogue once dailyPremixed/ premixed analogue pre-dinnerIntermediate acting (NPH) pre-breakfast and pre-dinnerPremixed insulin pre-breakfast and pre-dinnerBasal insulin once daily + 1 prandial insulinBasal insulin once daily + 2 prandial insulinPrandial insulin pre-breakfast, pre-lunch and pre-dinnerPremixed analogue pre-breakfast, pre-lunch and pre-dinnerPremixed insulin pre-breakfast, pre-dinner + 1 prandial insulin pre-lunchPrandial insulin pre-breakfast and pre-lunch + premixed insulin pre-dinnerBasal insulin once daily + prandial insulin pre-breakfast, pre-lunch and pre-dinnerIntermediate acting (NPH) insulin pre-breakfast and pre-dinner + prandial insulinpre-breakfast, pre-lunch and pre-dinnerInsulin therapy – 3 stage processINITIATIONStarting insulinStrat requires selection of appropriateinsulin regimen, insulin type andstarting dose.OPTIMISATIONDose titration to ensure maximumbenefit from prescribed treatmentDose should be adjustedevery 3-7 daysINTENSIFICATIONModification of an insulin regimento acieve glycemic controlRequires switching to more intensiveregimens for better glycemic controlIntensification of Premixed Regimen to Premix PlusPREMIXED OD (pre-dinner) or BDPREMIXED ONCE DAILY (pre-dinner)FPG 4-6 mmol/L, pre-lunch and pre-dinner > 6mmol/LAdd PRANDIAL INSULIN(at morning and midday meal)PREMIXED TWICE DAILY (pre-breakfast, pre-dinner)Pre-dinner > 6 mmol/LAdd PRANDIAL INSULIN(at midday meal)• Add prandial insulin 6 units or 0.1unit/kg• Titrate to next prandial BG target daily• If subsequent pre-meal BG is- < 4 mmol/L ( > 1 value ) → reduce dose by 2 units- 4-6 mmol/L ( all values ) → maintain current dose- > 6 mmol/L ( >1 value, no hypos ) → increase by 2 units