Diabetes for Designers Part 2: Medications, Monitoring, and the Day to Day

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Transcript

1. Joyce Lee, MD, MPH Pediatric Endocrinology, University of Michigan http://www.doctorasdesigner.com/ Twitter: @joyclee Diabetes: A Guide for Designers: Part 2: Medications, Monitoring, and the Day to Day
2. What is insulin?
3. Insulin is the hormone that allows the body to use glucose as energy, (i.e. it lowers blood glucose)
4. 70-120 mg/dl FYI a normal blood glucose is:
5. How do you give insulin?
6. Via injection (using either syringe or prefilled insulin pens) 3 Via insulin pump -or-
7. When do you give insulin?
8. Generally before meals, because blood glucose increases when you eat carbohydrates (starches like bread, rice, pasta)
9. Breakfast Lunch Supper Snack Blood Glucose The peaks shows how blood glucose would rise with each meal or snack during the day without insulin 7AM 12PM 6PM 9PM
10. So, before every meal or snack individuals have to give a little “burst” of insulin to keep the blood sugar down with the meal
11. We call this “bolus insulin”
12. Breakfast Lunch Supper Snack Blood Glucose The bolus insulin is a short acting insulin that blunts the rise of the blood sugar with a meal 7AM 12PM 6PM 9PM
13. However, in addition, individuals need a steady background dose of insulin even when they are not eating (This is because the liver makes glucose for the body between meals)
14. We call this “basal insulin”
15. Breakfast Lunch Supper Snack Blood Glucose For individuals on injections: They will take a basal insulin once a day usually at night (i.e. Lantus, Levemir) which lasts for approximately 24 hours 7AM 12PM 6PM 9PM 7AM 12PM 6PM 9PM
16. Breakfast Lunch Supper Snack Blood Glucose For individuals on insulin pumps: The pump gives a small dose of short acting insulin every hour over a 24 hour period which is the basal insulin 7AM 12PM 6PM 9PM 7AM 12PM 6PM 9PM
17. Here are example regimens
18. 7.5 Units Lantus Every night 7AM 12PM 6PM 9PM 7AM 12PM 6PM 9PM Humalog/Novolog given before each meal/snack using Carbohydrate ratio: 1:30 Correction factor: 1:120 Target blood sugar: 120 mg/dl Injection Therapy
19. Humalog/Novolog basal rate of 0.3 units/hr x 24 hr 7AM 12PM 6PM 9PM 7AM 12PM 6PM 9PM Humalog/Novolog given before each meal/snack using Carbohydrate ratio: 1:30 Correction factor: 1:120 Target blood sugar: 120 mg/dl Pump Therapy *There is only short acting insulin in a pump!
20. What the heck is a Carbohydrate Ratio?
21. The amount of insulin given to cover the amount of carbohydrates in a meal
22. A carbohydrate ratio of 1:30 means Give 1 unit insulin for every 30 gm carbohydrate ingested
23. What the heck is a Correction Factor?
24. The amount of insulin given to lower blood sugar if it is high 240
25. A carbohydrate ratio of 1:120 means Give 1 unit insulin to drop blood glucose by 120 points (mg/dl) to the target BG (Target BG is a BG in the normal range; some people use 120 mg/dl as the target)
26. So in the day to day, before each meal or snack individuals will do the following:
27. Step 1 Check blood glucose by pricking finger and using a blood glucose meter 240
28. 45 gm Step 2 Estimate carbohydrates that are about to be ingested
29. Step 3 Calculate insulin dose for carbohydrate Meal Carbohydrate Carbohydrate Ratio 45 30 = 1.5
30. Step 4 Calculate insulin dose if blood glucose is high Meter BG - Target BG Correction Factor 240-120 120 = 1
31. Step 5 Give insulin 1.5 units for Carbohydrates and 1 unit for correction = 2.5 units
32. We often give a chart like this to make calculations easier Carbs (g) Insulin (u) BS range Insulin (u) 30 gm +1 121-240 +1 60 gm +2 241-360 +2 90 gm +3 361-480 +3 120 gm +4 481-600 +4
33. In summary, individuals will perform up to 8-12 blood glucose checks a day, count carbohydrates with every meal/snack and give anywhere from 6-8 injections a day.
34. 35 or more diabetes interactions per day, not even counting other factors like stress, exercise, changes in environment or routine, pump failures, etc. That’s like
35. More to come, stay tuned. Questions? Twitter: @joyclee http://www.doctorasdesigner.com/