Would you adjust this patients regimen If so howSolutionInit

Would you adjust this patient\'s regimen? If so, how?

Solution

Initiating insulin regimes

Table A

Once Daily – Intermediate regimen

This may be used to supplement the daytime oral hypoglycaemic medication.

Use intermediate acting insulin, which provides a low background level of insulin.

Daily insulin requirements = 0.5 units / kg body weight approximately     e.g. 0.5 x 72kg = 36 units

Of which 50% will be basal requirement 36 x 50% = 18 units

Take 60% of this daily dose for ‘safety’     18 x 60% = 11 units Rounded up to 12 units for ease of administration

A safe starting dose would be e.g. 12 units of intermediate acting insulin, usually given at bedtime.

Table B

Once daily – Long acting regimen

The long-acting insulin analogues Glargine and Detemir are now available.

The Scottish Medicines Consortium (SMC) has advised on their use in Scotland.

Glargine is not recommended in patients with Type 2 diabetes unless they suffer from recurrent episodes of hypoglycaemia, but use of Glargine in the SoloStar device is acceptable for use as a once daily insulin therapy for patients who require carer administration of their insulin13.

The SMC recommend that Detemir use should be targeted on patients attempting to achieve better glycaemic control, but have accepted the use of Detemir in the InnoLet device for patients who have poor visual acuity and dexterity problems.

Table C

Twice Daily Regimen For twice daily regimens the most frequently used option is a premixed fixed combination of short and intermediate acting insulin or a rapid acting insulin lispro or aspart mix11.

A twice-daily intermediate acting insulin is an alternative choice and may be appropriate in the elderly where there is a concern regarding the risk of hypoglycaemia.

Daily insulin requirements = 0.5 units / kg body weight approximately e.g. 0.5 x 72kg = 36 units Take e.g. 60% ‘for safety’ 36 units x 60% = 22 units Split the dose 50%: 50% before breakfast and evening meal. i.e. 11 units bd. Rounded up to 12 units for ease of administration. Generally the final insulin dose required will be nearer to 60%/40% divide .