Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-91

Figure 5. Basal insulin, prandial insulin at one meal and daytime antihyperglycemic agents

• Insulin type and timing : o Rapid-acting insulin analogues (aspart, faster-acting insulin aspart, lispro, glulisine preferred) prior to the largest carbohydrate meal or breakfast. o Long-acting or ultra-long-acting basal insulin analogue (preferred) or intermediate acting insulin to target FBG. o Non-insulin antihyperglycemic agents: Target daytime control. • Dosage : o Initiate at 4 units prior to the largest carbohydrate meal or breakfast OR 10% of basal dose. o May need to reduce or discontinue insulin secretagogues to prevent or with the onset of hypoglycemia. • Benefits : o Stepped approach to physiological insulin replacement; only two injections. o Bolus insulin: Target postprandial BG after largest carbohydrate meal or breakfast. o Basal insulin: Can titrate to achieve/maintain FBG targets. o Individuals can be taught to titrate bolus dose by 1 unit daily to target a two-hour postprandial BG <8.0 mmol/L or 4-7 mmol/L before the next meal. o Able to adjust bolus dose based on BG levels, carbohydrate intake and activity levels related to that one meal.