Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-96

o Alternatively, can initiate at a dose of 0.5 units/kg/day. The total daily dose (TDD) insulin requirements: Two-thirds dose given before breakfast and one-third before dinner. o Dose breakdown: ⅔ intermediate insulin and ⅓ rapid/short-acting insulin. o Discontinue insulin secretagogues. May need to reduce the dose of other antihyperglycemic agents associated with hypoglycemia with onset of hypoglycemia. o Premixed insulin analogues should be taken just prior to the meal while premixed insulin should be given 30 to 45 minutes prior to the meal. o Simple regimen that requires only two injections to provide basal and bolus insulin coverage throughout the day. Option for people not wanting to progress beyond two injections a day. o May be suitable for people with type 2 diabetes that have a consistent lifestyle with regular meals and activity schedule. o Individuals can be taught to titrate dose by 1-2 units every day until targets reached. ▪ Increase breakfast dose until the pre-dinner target is met (4.0-7.0 mmol/L). ▪ Increase dinner dose until the fasting BG target is met (4.0-7.0 mmol/L). o The dose should not be increased if the individual has two episodes of hypoglycemia in one week or any nocturnal hypoglycemia. o Lack of mealtime flexibility: Must eat three meals ± need for snacks. o Higher rates of hypoglycemia and increased risk of weight gain. o Inability to fine-tune doses unless the person is willing to give a separate bolus injection. o Daytime control more difficult (use intermediate-acting insulin as a meal/bolus insulin). o Need to monitor glucose at least twice daily.

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