Irl B. Hirsch, M.D.University of Washington, Seattle.ppt

First, Why is Mealtime Insulin So Important? Raise your hand if you or your child take 1 shot daily Raise your hand if you or your child take 2 shots daily Raise your hand if you or your child take 3 shots daily Raise your hand if you or your child take 4 or more shots daily Raise your hand if you or your child wear an insulin pump Pearls with MDI: Prandial Insulin LAG times The amount of time between giving the prandial insulin and eating the meal Due to the timing of insulin absorption compared to carbohydrate absorption, insulin usually needs to be injected a minimum of 10 min prior to eating, even if glucose levels are within target. Longer lag times are required for pre-meal hyperglycemia Humalog with Different Lag Times Pearls with MDI: Prandial Insulin Insulin-on-Board (IOB) Correction Dose (insulin sensitivity factor) The amount of glucose reduction (in mg/dL) to expect from 1 unit of insulin Numerous formulas published but in general most type 1’s start with an ISF of about 50 Conclusion (3) Conclusion (1) After 84 years we are finally starting to understand a little about how to use insulin Conclusion (2) Although it is a lot of work, rewards later on are huge. Frequencies of PDR, ESRD, LEA are declining rapidly The number 1 barrier to type 1 diabetes therapy (especially in adults) in 2006 is…? * Irl B. Hirsch, M.D. University of Washington, Seattle Maximizing MDI Why do so many physicians frown when they meet patients with type 1 diabetes on one or two daily injections? 0 1 2 3 4 5 6 7 8 9 24 20 16 12 8 4 0 Risk for Retinopathy in Conventional and Intensive Treatment: Thinking Out of the Box Conventional Adapted from Diabetes 44:968-983, 1995 11% Rate Per Patient Year 10% 9% 8% 7% Time During Study (Years) Mean HbA1c Risk for Retinopathy in Subgroups of the DCCT 0 1 2 3 4 5 6 7 8 9 Intensive Rate Per Pa