Quick insulin dosing reference for residents Dept
Description: Quick insulin dosing reference for residents Dept of Pediatric Endocrinology Stony Brook Childrens Hospital Timing and Duration of Action of Insulin Preparations Twice daily Insulin dosing For two times a day injections.. 23 of total
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slide1. Quick insulin dosing reference for residents Dept of Pediatric Endocrinology
Stony Brook Children’s Hospital<br>
slide3. Timing and Duration of Action of Insulin Preparations<br>
slide4. Twice daily Insulin dosing For two times a day injections…..
2/3 of total daily dose in the am
1/3 rapid acting
2/3 NPH
1/3 of total daily dose in the pm
1/3 to ½ rapid acting
1/3 to ½ NPH<br>
slide5. Dawn Phenomenon Elevated blood glucose in the morning due to normal nocturnal secretion of GH and cortisol
Or waning of insulin action from the prior evening dose of NPH
Correct by increasing evening dose of NPH, may be limited by hypoglycemia in middle of night: preventable by changing NPH to pre-bedtime<br>
slide6. Rebound hyperglycemia
Peak activity of NPH causes unrecognized hypoglycemia in middle of the night
Counterregulatory hormones causes exaggerated rise in blood glucose resulting in hyperglycemia in the morning
Solution: the evening dose of NPH should be decreased to eliminate hypoglycemia at night<br>
slide7. Multiple Daily Injections ½ of total daily dose given as glargine (Lantus)
Rapid acting insulin to cover meals and correct high BGs
Insulin to carb (I:C) ratio can be determined by dividing 450 by the total daily insulin dose
Typical I:C for toddler 1:30 grams; teenager 1:5-8 grams
Insulin Sensitivity Factor (ISF) : 1800 rule is used: divided by the total daily insulin dose
If someone’s TDD= 30 units
1800/30= a 60 point drop per unit of insulin
Correction formula: (Current BG minus Target BG)/ISF<br>
slide8. Adjusting Insulin Doses Example 1 7 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide9. Adjusting Insulin Doses Example 1 7 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The dinner time blood glucoses are all high; increase AM NPH<br>
slide10. Adjusting Insulin Doses Example 2 5 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide11. Adjusting Insulin Doses Example 2 5 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The majority of the overnight numbers are low so decrease the evening NPH<br>
slide12. Adjusting Insulin Doses Example 3 15 year old who takes Novalog at meals breakfast and Lantus at bedtime has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide13. Adjusting Insulin Doses Example 3 15 year old who takes Novalog at meals breakfast and Lantus at bedtime has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The overnight and first morning blood gluocoses are high. Increase Lantus<br>
Stony Brook Children’s Hospital<br>
slide3. Timing and Duration of Action of Insulin Preparations<br>
slide4. Twice daily Insulin dosing For two times a day injections…..
2/3 of total daily dose in the am
1/3 rapid acting
2/3 NPH
1/3 of total daily dose in the pm
1/3 to ½ rapid acting
1/3 to ½ NPH<br>
slide5. Dawn Phenomenon Elevated blood glucose in the morning due to normal nocturnal secretion of GH and cortisol
Or waning of insulin action from the prior evening dose of NPH
Correct by increasing evening dose of NPH, may be limited by hypoglycemia in middle of night: preventable by changing NPH to pre-bedtime<br>
slide6. Rebound hyperglycemia
Peak activity of NPH causes unrecognized hypoglycemia in middle of the night
Counterregulatory hormones causes exaggerated rise in blood glucose resulting in hyperglycemia in the morning
Solution: the evening dose of NPH should be decreased to eliminate hypoglycemia at night<br>
slide7. Multiple Daily Injections ½ of total daily dose given as glargine (Lantus)
Rapid acting insulin to cover meals and correct high BGs
Insulin to carb (I:C) ratio can be determined by dividing 450 by the total daily insulin dose
Typical I:C for toddler 1:30 grams; teenager 1:5-8 grams
Insulin Sensitivity Factor (ISF) : 1800 rule is used: divided by the total daily insulin dose
If someone’s TDD= 30 units
1800/30= a 60 point drop per unit of insulin
Correction formula: (Current BG minus Target BG)/ISF<br>
slide8. Adjusting Insulin Doses Example 1 7 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide9. Adjusting Insulin Doses Example 1 7 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The dinner time blood glucoses are all high; increase AM NPH<br>
slide10. Adjusting Insulin Doses Example 2 5 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide11. Adjusting Insulin Doses Example 2 5 year old who takes Humalog and NPH at breakfast and dinner has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The majority of the overnight numbers are low so decrease the evening NPH<br>
slide12. Adjusting Insulin Doses Example 3 15 year old who takes Novalog at meals breakfast and Lantus at bedtime has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less?<br>
slide13. Adjusting Insulin Doses Example 3 15 year old who takes Novalog at meals breakfast and Lantus at bedtime has the following blood glucoses. Do you want to make any changes to the insulin plan? If so, at which injection time, which insulin, and do you want to give more or less? ANSWER: The overnight and first morning blood gluocoses are high. Increase Lantus<br>