Diabetes During Intercurrent Illness In The 糖尿病并发的疾病管理中的课件.pptVIP

Middle arm - insulin stopped in Type 2 DM (consider if low dose) Urinalysis for daily glucose check. If over 2+glucose - then capillary glucose. If above 20mmol/l then give 6units rapid acting insulin + recheck glucose in 2hrs If individual requires rapid acting insulin more than twice then consider daily Isophane/Lantus May be simpler to resume smaller dose of usual insulin… N.B Basal insulin at least to continue in Type 1 Managing the effects of steroid therapy Steroid therapy is frequently used in palliative care for symptom control, usually as dexamethasone or prednisolone. The impact of steroids on glucose control can cause additional hyperglycaemic symptoms. Once daily steroid therapy taken in the morning tends to cause a late afternoon or early evening rise in glucose levels which can be managed by a morning sulphonylurea (e.g. Gliclazide) or morning Isophane insulin (e.g. Insulatard, Humulin I or InsumanBasal). Typical uncontrolled glucose profile (in estabilshed DM) with steroids dosed in morning Break 2 hrs lunch 2hrs Eve meal 2 hrs bed 5.4 14 20.5 13.4 18 6.2 23.6 12.4 32.1 20 5.9 28.9 Slide no * ? UK/DB/0309/0079 Date of Preparation: March 2009 ? Intermediate-acting insulin (NPH or Isophane) Cloudy insulin - crystals in suspension (need to re-suspend prior to injection) Onset 1 1/2 hours Peak 6-10 hours Duration of action generally up to 16-18hrs Note: The graphical representation above is for educational and illustrative purposes only Time Action Slide no * ? UK/DB/0309/0079 Date of Preparation: March 2009 ? Premixed combinations: Premixed combinations of fast/rapid and intermediate-acting insulin Cloudy (needs re-suspending) Onset 10-30 minutes Novomix 30, Humalog Mix 25/Mix 50/Humulin M3 Time Action Steroids cont’d If steroids are to be given twice daily, for example splitting higher doses of dexamethasone, it will be necessary to recommend an alternative approach to setting times fo