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

joyclee
July 02, 2013
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Diabetes for Designers Part 2: Medications, Monitoring, and the Day to Day

joyclee

July 02, 2013
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  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. Insulin is the hormone that allows the body to use

    glucose as energy, (i.e. it lowers blood glucose)
  3. Generally before meals, because blood glucose increases when you eat

    carbohydrates (starches like bread, rice, pasta)
  4. 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
  5. So, before every meal or snack individuals have to give

    a little “burst” of insulin to keep the blood sugar down with the meal
  6. 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
  7. 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)
  8. 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
  9. 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
  10. 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
  11. 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!
  12. A carbohydrate ratio of 1:30 means Give 1 unit insulin

    for every 30 gm carbohydrate ingested
  13. 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)
  14. So in the day to day, before each meal or

    snack individuals will do the following:
  15. Step 4 Calculate insulin dose if blood glucose is high

    Meter BG - Target BG Correction Factor 240-120 120 = 1
  16. 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
  17. 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.
  18. 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