Insulin Adjustment Guidelines

General Principles

Insulin adjustment is an art that should be guided by the science of what is known about how each component insulin of the total daily insulin requirement acts and how lifestyle and other variables impact BG levels. Insulin adjustment guidelines are grounded in a sound knowledge of the pharmacokinetics of insulin, as discussed earlier in this chapter. When BG levels are outside target ranges and it is determined that an adjustment in insulin dosing is necessary, knowledge of the action curves of the insulins that the patient is taking will guide the decision as to how to adjust the insulin regimen appropriately (Fig. 1). The information presented in the following section is a composite of published information on this topic and a consensus of the accumulated clinical experience of the authors in caring for adult patients with DM1. We have attempted in presenting this information to provide a practical framework upon which the reader may build and convey to one's patients the nuts and bolts of pattern management insulin adjustments.

For the patient with DM1 on an MDI regimen or using an insulin pump, the underlying principles for adjusting the insulin regimen are essentially the same. Fasting BGs that are not well-controlled will be corrected by adjusting the basal insulin dose(s), i.e., if the fasting BG is low, the basal insulin dose will be decreased and if the fasting BG is high, the basal insulin dose will be increased. Postmeal BGs that are not well-controlled will be corrected

"t 1 I ■>■ 111 I- T I —1—1 (I f 2 3 4 5 6 7 8 9 1011 12 13 14 15 16 17 1819 20 a 22 23 24

Hours

Hlnch IB. Ma&cqpeGan Med. £005:7:49. Punk J. eta I. CMeeies Cme. I005r2S:l 107-1111. Ra« K. it al.Diibetes Cure. 2005r28:1099* 1032. Used Ai'h permission horn the Council for the Miarxem-wt Dlatetes Research jiKt Education (CADRE).

Aspnrt, glulisine, lispro (4-5 hours)

Aspnrt, glulisine, lispro (4-5 hours)

Hours

Hlnch IB. Ma&cqpeGan Med. £005:7:49. Punk J. eta I. CMeeies Cme. I005r2S:l 107-1111. Ra« K. it al.Diibetes Cure. 2005r28:1099* 1032. Used Ai'h permission horn the Council for the Miarxem-wt Dlatetes Research jiKt Education (CADRE).

1 Inhaled insulin (4-9 hours) Regular (6-8 ho lire) NPH (1-16 hours) hi Del euii r (-20 hours)

Figure 1 Time-action profiles of available insulin preparations. Source: http://www.insulinideas. org/pdf/InsulinIDEASNewsV1N3Q7final_Oct2006.pdf (2/12/2007).

Table 3 General Principles for Adjusting the Insulin Regimen
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