|Table 1 | | | |
|Insulin | | | |
|Therapy | | | |
|According| | | |
|to | | | |
|Severity | | | |
|of Type 2| | | |
|Diabetes | | | |
|The | | | |
|severity | | | |
|of | | | |
|hyperglyc| | | |
|emia | | | |
|in-patien| |
| |
|ts with | | | |
|type 2 | | | |
|diabetes,| | | |
|as judged| | | |
|by | | | |
|glucose | | | |
|levels | | | |
|during | | | |
|diet and | | | |
|exercise | | | |
|therapy, | | | |
|can serve| | | |
|as a | | |
|
|guide to | | | |
|insulin | | | |
|therapy | | | |
|Fasting | | | |
|plasma | | | |
|glucose | | | |
|FPG is | | | |
|the chief| | | |
|index of | | | |
|disease | | | |
|severity | | | |
|in | | | |
|patients | | | |
|whose | |
| |
|endogenou| | | |
|s insulin| | | |
|secretion| | | |
|is still | | | |
|able to | | | |
|cover | | | |
|postprand| | | |
|ial | | | |
|glucose | | | |
|excursion| | | |
|s ie, | | | |
|restore | | | |
|glucose | | |
|
|to | | | |
|fasting | | | |
|levels | | | |
|within 4 | | | |
|to 5 | | | |
|hours | | | |
|Severity |FPG |Postprandial|Approach to Insulin Therapy |
| | |Insulin | |
| | |Response | |
|Mild |130 mg/dl 78 mmol/L |Sufficient |Insulin virtually never needed |
|Moderate |130-200 mg/dl 78-139 mmol/L|Sufficient |Endogenous insulin controls |
| | | |mealtime glucose excursions Basal|
| | | |insulin therapy usually adequate |
| | |
|with |
| | | |Bedtime intermediate-acting |
| | | |insulin OR |
| | | |Once-daily long-acting insulin OR|
| | | | |
| | | |Insulin pump therapy |
| | | |Total insulin: 03 to 06 |
| | | |U/kg/day |
|Severe |200mg/dl |Insufficient|Around-the-clock insulin needed |
| |139 mmol/L |in some |Short-acting or rapid acting |
| | |patients |insulin may be needed by some |
| | | |patients |
| | | |Basal therapy with |
| | | |Twice-daily intermediate-acting |
| |
| |insulin OR |
| | | |Once-daily long -acting insulin |
| | | |OR |
| | | |Insulin pump therapy |
| | | |Total insulin: 05 to 2 u/kg/day,|
| | | |possibly up to 15 U/kg with |
| | | |gradual reduction |
|Very |250-300 mg/dl139-167 |Severely |Around-the-clock insulin needed |
|severe |mmol/l |deficient |Basal and meal-real insulin needs|
| | | |managed similarly to type 1 |
| | | |diabetes However, endogenous |
| | | |insulin secretion may improve |
From: Perspectives in Diabetes Management, Volume 1, No 2, Winter 2001
Source:synspectrum.com
