Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-52

Sum of current-dose method For someone currently on insulin, obtain the TDD by adding up the basal and baseline bolus doses or, if on a premixed insulin, total all of the current doses. When switching insulin regimens from two to three insulin daily injections to four or five daily injections, the TDD is often reduced by 10% in anticipation of a more physiological regimen (74). The degree to which the dose is reduced will depend on several factors: glycemic control, A1C, presence of nocturnal hypoglycemia, level of hypoglycemic awareness, patient comfort/anxiety regarding basal rate, patient’s willingness and ability to SMBG overnight and clinical judgement. It is advisable to calculate the estimated TDD by the weight method as well and compare the two results. If there is a big discrepancy, clinical judgement and patient input should help guide the decision.

BBI Examples: Insulin 30/70 BID; 24 units before breakfast and 16 units before dinner TDD: 24 + 16 = 40 units Reduce by 10% (TDD: 40 – 4 = 36 units) New TDD = 36 units

Insulin NPH 20 units before breakfast and NPH 35 units at bedtime; rapid-acting insulin 10 units at breakfast and 20 units at dinner TDD: 20 + 35 + 10 + 20 = 85 units Reduce by 10% (TDD: 85 – 8.5 = 76.5 units) New TDD = 76 units

Meet ing basal requirements For someone switching to CSII: • TDD should be reduced from 10-25% (121).

• TDD should also be calculated by weight and compared to the TDD based on sum of current-dose method. If there is a large discrepancy between the 2 methods, then clinical judgement is used to decide the TDD.