Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-90

o Do not increase dose if person with diabetes has two episodes of fasting hypoglycemia in one week or one episode of nocturnal hypoglycemia. • May need to reduce the dose of antihyperglycemic agents associated with hypoglycemia (especially insulin secretagogues) if hypoglycemia occurs. O The individual/caregiver must be able to (self-)administer insulin. o Intermediate-acting insulin and long-acting basal analogue insulins must be administered within an hour of the usual time (bedtime 10:00-11:00 pm) to ensure consistency and sufficient insulin to cover the dawn phenomenon. [Ultra-long acting basal analogues insulins are best administered at the same time every day, not necessarily at bedime, although there is more flexibility in administration timing with ultra-long-acting basal analogues.] Basal plus strategy: Adding bolus insulin once daily to optimize basal insulin therapy (24,205-207) When intensification of insulin is required to achieve glycemic targets, and after the dose of GLP-1 RA and/or SGLT2i is optimized, (see figure 3) a single injection of prandial insulin should be added to either the meal with the greatest carbohydrate load or breakfast. This option provides more physiologic insulin replacement as additional doses of prandial insulin can be added to other meals as needed, providing a stepped approach to a full basal-bolus insulin regimen. • Limitations :