Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-94

▪ 40% of the TDD as basal insulin (degludec, glargine U-300/U-100, detemir, NPH). ▪ 20% of the TDD as bolus prandial insulin three times a day (aspart, faster- acting aspart, lispro, glulisine). ▪ If transitioning from premixed insulin to basal-bolus insulin regimen, one may need to reduce the TDD by 10 to 20% in anticipation of reduced insulin requirements due to more physiologic insulin replacement. o Provides increased flexibility as the individual can make adjustments in insulin dose based on blood glucose levels and changes in food and/or activity. o Able to correct hyperglycemia quickly (rapid-acting insulin analogues preferred). o Reduces risk of midday and overnight hypoglycemia. o Requires motivation to take four to five injections/day and independent self-care. o Frequent BG monitoring: at least four times a day (208) or access to continuous glucose monitoring (CGM). o More expensive (increased cost with glucose monitoring supplies and the use of insulin cartridges). o Requires the support of a DHC team to learn advanced self-management skills, such as pattern management, carbohydrate counting and insulin dose adjustment for exercise.

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• Limitations: