Mr. Chu is a 72 year-old man with long-standing T2DM, poor control on maximum metformin, glyburide, and pioglitazine. He agrees to start on MDI. He weighs 100 kg.
Write a reasonable order for insulin, including correction factor.
Weight (kg) * 0.5 = total daily dose of insulin (TDD)
= 100 * 0.5
= 50 units
Half of insulin as rapid acting, half as long acting:
Aspart or lispro or glulisine or regular: 8 units tid ac meals
Glargine or Detemir: 25 units OR 60% Regular;
40% NPH: 10 units Regular tid ac meals,
NPH 20 units qhs (NPH may need to be split into 2 doses)
100 / TDD
= 100 / 50
1 unit lowers glucose by 2 mmol/L.
If Pre-meal glucose is…
- 4-8 mmol/L, give 8 units Regular
- 8-10 mmol/L, give 9 units Regular
- 10-12 mmol/L, give 10 units Regular
- >12 mmol/L, give 11 units Regular
What medication(s) would you discontinue?
Glyburide and Pioglitazone will be stopped.
Metformin will be continued to reduce weight gain on insulin and lower the dose of insulin required.