Basic methods of insulin dose setting

First determine glycemic control targetsThe American Diabetes Association (ADA) in 1996 established a revised diagnostic criteria for diabet

Content

First determine glycemic control targets

The American Diabetes Association (ADA) in 1996 established a revised diagnostic criteria for diabetes, according to the new criteria for the diagnosis of diabetes in ADA, where any of the following can be diagnosed as diabetes.

1 fasting blood glucose than 7.0mmol/L (more than 126mg/dl), and the symptoms of diabetes (polydipsia, polyphagia, polyuria, weight loss, etc.).

2 random blood glucose over 11.1mmol/L (more than 200mg/dl).

The amount of 3 glucose tolerance test (OGTT) in 2H blood glucose over 11.1mmol/L (more than 200mg/dl).

Identify individual glycemic control targets for each patient.

General control objectives for adult patients:

Before meals: 80-140mg/dl (4.4-7.8mmol/l)

2 hours after meals: 5mmol/l)

If recurrent hypoglycemia, appropriate to improve control objectives:

Before meals: 100-160mg/dl (5.6-8.9mmol/l)

If pregnant, appropriate to reduce the target blood glucose:

After dinner: < 120mg/dl (6.7mmol/l)

Preparatory work (1)

Physician or medical team to provide consulting services

Family members or other relatives receive diabetes education

Multiple blood glucose self-monitoring (before and after meals, bedtime, 0Am, 3Am, and hypoglycemia or hyperglycemia)

Fixed diet plan (before the end of the base rate adjustment, do not eat too much fat food, do not eat snacks before going to bed)

Comparison of capillary blood glucose and venous blood glucose

Preparatory work (two)

And long-acting insulin washout:

Effect: 18 - 20 hours

Long lasting: at least 24 hours

Selective injection site:

Abdomen: the fastest absorption of insulin, more predictable, less affected by activity

Replacement of parts:

Other options include the hips, upper thighs, upper arms, and a 3 5cm

Initial daily dose calculation

Total daily insulin

Calculated according to body weight (not insulin)

Day total = body weight * 0.44

According to the amount of the pump before use (blood glucose control can be)

The total amount of a day before the use of insulin pump * (75%-80%)

Initial base amount

Total insulin count

Starting base = 1 day total * 50%

Calculated according to weight

Initial base weight = X0.22

Be careful:

1) the average individual users start from a single base rate, the basic rate of the average distribution of 24 hours, according to the results of the next day's blood glucose monitoring to determine whether to increase the rate of second basis.

2 (clinical) generally divided into three to five segments: 0:00-4:00am;

4:00am-8:00am; 8:00am-12pm.

High dose before meal

The total dose of total meal = 50%

Distribution:

Method A: according to the number of meals per meal distribution,

Large dose before breakfast = 1 day total * 20%

A large dose of Chinese food = 15%

Large dose before dinner = 1 day total * 15%

Method B: calculated according to carbohydrates

Because of the different insulin sensitivity of the individual, about 1 grams of carbohydrates per 12-15 grams of insulin, the body needs a large amount of large.

Use of supplemental dose

High blood glucose was measured before the meal, and the supplementary dose of 100% was added before the meal

Postprandial blood glucose measurement can be given 80% (to prevent hypoglycemia)

High blood sugar was measured before bedtime, but 50%~80% was given (to prevent hypoglycemia)

The principle of adjusting base quantity

The basal rate should be adjusted for 2 to 3 hours before the onset of blood glucose (short acting insulin) or for up to 1 hours (ultra short acting insulin)

Each adjustment should be increased or decreased by 0.1u/ hours (especially for type 1 patients)

For example: the patient (the use of short acting insulin glucose in the morning) began to decline in 1, then in 10 point and 11 point to set a lower rate, the base rate per hour decreased gradually to achieve 0.1U target.

60% patients will appear dawn phenomenon, if there is this phenomenon, can be doubled, especially 5am - 7am

On the basis of the clinical rate from 3-5 to

Insulin pump treatment of blood sugar (1)

Eight blood glucose test:

Breakfast BG 2 hours before breakfast BG

Chinese food before lunch 2 hours BG BG

BG dinner 2 hours before dinner BG

BG am 3 a.m. BG

Insulin pump treatment of blood sugar (two)

Adjust the high dose before meals:

According to BG 2 hours after each meal, compared with the same meal before BG, adjust the amount of pre meal

Increased: the amount before meals

Balance: not adjusted

Reduction: before meals

Give an example

According to the 1500 rule, insulin sensitivity coefficient X=1500/ total insulin (mg/dl)

Assume that a total of 30 units of insulin, X=1500 / 30=50mg/dl, a unit of 50 mg of /dl insulin can reduce blood glucose within 2~5 hours

Such as pre prandial blood glucose is 10mmol/L plus 5 units of large doses before meals, postprandial blood glucose is 15mol/L

Add less insulin n (15mmol/L-10mmol/L) * 18] / 50 mg /dl=1.8

That is the pre meal high dose can be adjusted for (51.8) = 6.8 units

Insulin pump treatment of blood sugar (three)

Adjusted base rate:

Before each meal meal before BG and 2 hours after meal compared to BG (2 hours after dinner before going to bed vs, 3am vs and vs 3am before going to bed before breakfast), change more than 2mmol/L, at least 2 to 3 hours to increase or decrease the base rate, to 0.1 units per hour or.

Give an example

A patient after dinner 2 hours BG for 8mmol/L[8pm], before going to bed for 10.5mmol/L[10pm], in the morning for the 8.0mmol/L[3am] of the abdomen is 5.8mol/L[6Am]

8pm-10pm: 0.1 units per hour;

10pm-0am: unchanged;

0am-3am: 0.1 units per hour;

3am-6am: 0.1 units per hour.

Fine adjustment of base rate

During the detection, the blood glucose was controlled within the range of 30 mg/dl (1.7mmol/L) of the target blood glucose.

It is important to stabilize the other parameters in the first few days.

It is difficult to calculate a large dose of a meal before eating a standard meal to prevent the delay of fat foods.

When testing the base rate, don't do strenuous exercise unless it's a daily exercise.

Do not base rate detection during illness or infection.

The following conditions need to be adjusted

Significant changes in body weight: increased or decreased by more than 5-10%

Significant change in activity

Low calorie diet (weight loss): base rate reduced by 10%-30%

Pregnancy: 3am base rate decreased by 2 to 3 times at dawn (compared with 3am base rate)

Duration of illness or infection: usually an increase in base rate

Menstruation: increase the basal rate before menstruation, menstruation may

Reduced base rate

Combined with other drugs: such as prednisone, need to increase the base rate

Application time before meal

30 minutes before meals

Pre test meal

High dose of injection

Blood glucose was measured 2 hours after meal

 

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