case studies insulin start and administratrion
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International Diabetes Center
International Diabetes Center
Case Study #1
•
48 year old female
•
Type 2 diabetes for 10 years
•
Current therapy: Combination Oral Agent (metformin 1000 mg
bid and glimeperide 6 mg/day)
•
Height 1.6 meters Weight 68 kg.
•
Blood pressure 128/82 mmHg
•
HbA1c 8.7%
•
Targets:
HbA1c < 7%
Fasting/Pre-meal BG 70-140 mg/dL (3.9-7.7 mmol/L)
International Diabetes Center
International Diabetes Center
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
179
179
(9.9)
(9.9)
189
189
(10.5)
(10.5)
206
206
(11.4)
(11.4)
198
198
(11.0)
(11.0)
147
147
(8.2)
(8.2)
139
139
(7.7)
(7.7)
142
142
(7.9)
(7.9)
160
160
(8.9)
(8.9)
Met
Glim
Met
Glim
Case #1 Log Book
Met = metformin Glim = glimeperide
(mmol/L)
International Diabetes Center
International Diabetes Center
Recommendations
•
What therapy would you recommend?
–
Continue current therapy?
–
Change diet only?
–
Start Combination Oral Agent/Insulin therapy?
–
Start insulin and stop oral agent?
•
Why?
International Diabetes Center
International Diabetes Center
Orders
•
Medication:
•
Dose:
•
Timing:
•
Blood glucose testing:
•
Target:
–
Blood glucose
–
HbA1c
International Diabetes Center
International Diabetes Center
Case #2
•
45 year old executive male newly diagnosed with
type 2 diabetes
•
HbA1c 13%; BG in office 20.3 mmol/L (366 mg/dL)
•
Symptoms: fatigue, polyuria, nocturia
•
Urine ketones negative
•
Height 1.7 meters; weight 74 kg
International Diabetes Center
International Diabetes Center
Recommendations
•
What therapy would you start?
–
Medical Nutrition Therapy?
–
Oral Agent?
–
Combination Oral Agent?
–
Insulin?
•
Why?
International Diabetes Center
International Diabetes Center
Orders
•
Medication:
•
Dose:
•
Timing:
•
Blood glucose testing:
•
Target:
–
Blood glucose
–
HbA1c
