case studies adjusting insulin
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International Diabetes Center
International Diabetes Center
Case Study #1
•
48 year old female with type 2 diabetes x 10 years
•
Current therapy
–
Metformin 1000 mg bid and Glargine 28 units at bedtime
•
HbA1c 7.9%; Weight 65 kg.
Breakfast
Breakfast
Lunch
Lunch
Ev. Meal
Ev. Meal
Day
Day
Pre
Pre
Post
Post
Post
Post
Pre
Pre
Pre
Pre
Bed
Bed
1
1
2
2
4
4
3
3
142
142
(7.9)
(7.9)
139
139
(7.7)
(7.7)
111
111
(6.2)
(6.2)
124
124
(6.9)
(6.9)
129
129
(7.2)
(7.2)
Met
Met
28 G
5
132
(7.3)
196
(10.9)
184
(10.2)
(10.2)
202
(11.2)
(11.2)
136
(7.6)
(7.6)
(mmol/L)
International Diabetes Center
International Diabetes Center
Recommendations
•
Continue current therapy?
•
Change/add oral agent?
•
Adjust insulin?
•
Add rapid acting insulin?
International Diabetes Center
International Diabetes Center
Orders
•
Medication:
•
Dose:
•
Timing:
•
Blood glucose testing:
•
Target:
–
Blood glucose
–
HbA1c
International Diabetes Center
International Diabetes Center
Case Study #2
•
64 year old female with type 2 diabetes for 6 years
•
Current treatment is 70/30 insulin twice per day
–
AM 30 units PM 18 units
•
Height 1.7 meters, weight 69 kg
•
Hypoglycemia 3x/week mid afternoon usually
•
HbA1c 8.2%
International Diabetes Center
International Diabetes Center
Case Study #2
Logbook
Breakfast
Breakfast
Lunch
Lunch
Ev. Meal
Ev. Meal
Day
Day
Pre
Pre
Post
Post
Post
Post
Pre
Pre
Pre
Pre
Bed
Bed
1
1
2
2
4
4
3
3
185
185
(10.3)
(10.3)
166
166
(9.2)
(9.2)
179
179
(9.9)
(9.9)
144
144
(8.0)
(8.0)
189
189
(10.5)
(10.5)
30 U
70/30
18 U
70/30
5
201
(11.2)
134
(7.4 )
123
(6.8)
(6.8)
118
(6.6)
(6.6)
196
(10.9)
(10.9)
62
62
218
(12.1)
(12.1)
58
58
192
(10.7)
174
(9.7)
228
(12.7)
66
66
(mmol/L)
International Diabetes Center
International Diabetes Center
Recommendations
•
Continue current therapy?
•
Add oral agent?
•
Adjust insulin?
•
Change to physiologic insulin regimen?
International Diabetes Center
International Diabetes Center
Orders
•
Medication:
•
Dose:
•
Timing:
•
Blood glucose testing:
•
Target:
–
Blood glucose
–
HbA1c
