Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-51

Patient Choice

With the revolutionary developments in CSII and sensor use it seems logical that these would be the tools of choice for most type 1 patients and many insulin using type 2 patients. However many patients are aware of the advantages of pump use but choose not to engage. As stated earlier, pumping is not for everyone. As a diabetes educator it is our role to facilitate an informed choice and support the patient in their decision.

Pump therapy will be discussed in more detail later in this chapter..

CALCULATING STARTING DOSES FOR BBI and CSII

Once the choice of insulin delivery system is made, the next step is to calculate starting baseline doses. Generally, 40 to 50% of the TDD of insulin is needed to fulfil basal requirements and the remaining 50 to 60% is needed for prandial requirements. Published formulae for calculating these doses are based on the patient’s weight and/or current insulin doses (38,72,73). Patients will need to be counselled regarding the nature of a “starting dose”. They should anticipate dose evaluations and adjustments will be required. It is important to set clear and realistic expectations of a “starting dose” to avoid a sense of personal and therapy failure. Calculating a starting baseline dose Calculating a baseline dose is based on either: 1. Body weight, or 2. The sum of the current total daily dose (TDD) (sum of basal and bolus doses). Calculat ing by weight Insulin requirements for adults with type 1 diabetes generally range from 0.3 to 1.0 units per kg of current body weight per day (73). The 2018 Guidelines recommend 0.3 to 0.5 units per kg when initiating people with type 2 diabetes on insulin (120). A lower unit per kg may be used during the “honeymoon phase” when there is some endogenous insulin secretion or in the elderly or those with real impairment. Starting with 0.5 units per kg is typically used for an insulin-naive person’s initial TDD (72). Example:

TDD = 80 kg x 0.5 units per kg = 40 units TDD = 40 units