調整餐前速效胰島素劑量.ppt

* * * Key Points: Elevated fasting glucose indicates need for basal insulin to suppress gluconeogenesis overnight. With basal insulin, patient needs to be on at least one oral agent to address mealtime glucose excursions Elevated post-meal glucose indicates need for bolus insulin to cover meal related carbohydrate intake. Most common starting points are Basal Insulin and Mixed Insulin but both point to Basal/Bolus regimen of increased flexibility. Note page reference (3-5) to 4th edition Quick Guide to get people into the SDM materials. Insulin detemir is a new basal insulin that is expected to be approved by FDA by the end of 2005. * * * * Doses need to be titrated on a regular basis Increase equally between doses if over 200 by 0.1 unit/kg For BG readings below 100, look at Table 6 as a guide for titrating insulin * * * * Titrating background insulin focus on am fasting BG. Once you reach 0.5 units/kg body weight, explain to the patient that a RA insulin will need to be added If fasting BG is in target and A1C 7%, it means that there are other timepoints throughout the day where the patient is having higher blood sugar. Ask them to do some post meal testing. This also helps them see that theyre a partner with you in taking care of their diabetes. They provide you with importnat information which in turn helps you to make the best decision for them. * * * Analog Premixes: More Options to Individualize and Fewer Injections * This slide demonstrates the key nutrition messages for the various insulin regimens described by Dr. Bergenstal. This information is also on Table 4 in the Guide to Starting and Adjusting Insulin for Type 2 Diabetes. Note also on the algorithm, that on the right side-bar, there are initial nutrition messages given. For those patients put on a background insulin it helps glucose control if they control their carbohydrates throughout the day. A suggestion to get started is to tell the patient to have 3-4 carb choices per meal until they