II. Protocol: Goal Blood Glucose for Type I and Type II Diabetes

  1. Hemoglobin A1C <7%
  2. Goal: >50% of Blood Sugars in range
    1. Pre-meal Blood Glucose 70-120 mg/dl
    2. Two hour post-prandial Blood Glucose <160 mg/dl
    3. Bed-time Blood Glucose 100-140 mg/dl

III. Evaluation: Blood Sugars

  1. Monitoring pointers
    1. Be consistent in monitoring
    2. Aim for 50% of Blood Glucoses in target range
  2. Look for consistent pattern in Blood Sugars for >3 days
    1. Compare Blood Sugar for same time each day
    2. For each time of day:
      1. Calculate Blood Glucose range
      2. Calculate median Blood Glucose
    3. Consider eating and activity patterns during day
    4. Ignore spurious values
  3. Adjust only one Insulin dose at a time
    1. Correct Hypoglycemia first
    2. Correct highest Blood Sugars next
    3. Maintain a 50:50 mix of Basal to Bolus Insulin

IV. Evaluation: Adjustment of Insulin

  1. Adjustment factors (for lows and highs)
    1. Adjust Insulin in small steps at a time
    2. Adjustment steps based on Insulin amount
      1. Insulin dose <10 units: Adjust by 1 unit
      2. Insulin dose 10-20 units: Adjust by 2 units
      3. Insulin dose >20 units: Adjust by 10% Insulin dose
    3. Adjustment steps based on diabetes type
      1. Type I Diabetes Mellitus: 1-2 units change
      2. Type II Diabetes Mellitus: 2-4 units change
  2. Correction protocol for Hypoglycemia
    1. General measures to consider
      1. Increase carbohydrate preceeding low
        1. Carbohydrate at prior meal or
        2. Snack or
        3. Pre-Exercise carbohydrate
      2. Adjust Exercise timing during the day
    2. Basal Insulin (e.g. Lantus) adjustment
      1. Blood Glucose low in AM
        1. Decrease basal Insulin (Lantus)
    3. Rapid acting Insulin (e.g. Lispro) adjustment
      1. Blood Glucose low before lunch
        1. Decrease rapid Insulin (Lispro) at breakfast
      2. Blood Glucose low before dinner
        1. Decrease rapid Insulin (Lispro) at lunch
      3. Blood Glucose low before bedtime
        1. Decrease rapid Insulin (Lispro) at dinner
  3. Correction protocol for Hyperglycemia
    1. General measures to consider
      1. Decrease carbohydrate preceeding high
        1. Carbohydrate at prior meal or
        2. Stop or decrease snack
      2. Increase Exercise prior to meal
    2. Adjust Insulin based on Carbohydrate Count
      1. See Insulin Adjustment with Carbohydrate Counting
      2. One Unit covers each 10-15 grams carbohydrate
      3. Add 1-2 units for every 50 mg/dl Glucose >150
    3. Indications to adjust basal Insulin (e.g. Glargine)
      1. All Blood Glucoses >200 mg/dl
        1. Increase basal Insulin by 0.1 units/kg
      2. All Blood Glucoses high (within 50 mg/dl)
        1. Increase basal Insulin per adjustment above
      3. Pre-supper Blood Glucose high
        1. Adjust basal Insulin per adjustment above
      4. Fasting (AM) Blood Glucose high
        1. Perform 3 am Blood Sugar checks
        2. Critical to distinguish 3 AM low BG from high BG
          1. Dawn Phenomena (relative Insulin deficiency)
            1. Increase basal Insulin by adjustment above
          2. Somogyi Phenomena (Rebound Hyperglycemia)
            1. Decrease basal Insulin by adjustment above
    4. Indications to adjust Bolus Insulin (e.g. Lispro)
      1. Two hour post-prandial >40-60 mg/dl over premeal
        1. Increase rapid acting Insulin before meal
      2. Blood Glucose low before meal
        1. Decrease rapid Insulin before prior meal
  4. Average Insulin doses after titrating from start
    1. Type I Diabetes Mellitus: 0.7 units/kg
    2. Type II Diabetes Mellitus: 1.2 units/kg

Images: Related links to external sites (from Google)

Related Studies (from Trip Database) Open in New Window

Ontology: Insulin (C0021641)

Definition (NCI) A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Definition (NCI) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism.
Definition (CSP) protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose and is also an important regulator of protein and lipid metabolism; insulin is used as a drug to control insulin-dependent diabetes mellitus.
Definition (MSH) A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D007328
SnomedCT 325014006, 67866001, 39487003, 412222002
LNC LP70329-5, LP16325-0, LP14676-8, LP32542-0, MTHU002108, MTHU019392, LA15805-7
English Insulin, insulin, Regular Insulin, Soluble insulin, Insulin Regular, insulin preparations, insulin preparations (medication), insulin regular, Insulin [Chemical/Ingredient], insulin products, insulin preparation, insulin product, regular insulin, insulins, Insulin, Soluble, Soluble Insulin, Soluble insulin (substance), Insulin regular, Insulin, Regular, Insulin product, Insulin (substance), Insulin preparation, Insulin product (product), Regular insulin product, Unmodified insulin product, Insulin preparation, NOS, Regular insulin preparation, Unmodified insulin preparation, Insulin preparation (substance), Regular insulin (substance), Regular insulin, INSULIN
Swedish Insulin
Finnish Insuliini
French Insuline ordinaire, Insuline soluble, Insuline
Russian INSULIN, ИНСУЛИН
Spanish producto con insulina (producto), preparado insulínico, insulina (producto), producto con insulina, insulina (sustancia), insulina, preparado de insulina (producto), preparado de insulina (sustancia), preparado de insulina cristalina de cinc, preparado de insulina cristalina de zinc, preparado de insulina no modificada, preparado de insulina, insulina regular (sustancia), insulina regular, Insulina
Italian Insulina regolare, Insulina
Croatian INZULIN
Polish Insulina
Japanese インスリン, インスリン亜鉛水性懸濁液, インシュリン
Czech inzulin, insulin
Norwegian Insulin, Oppløselig insulin
German Insulin
Portuguese Insulina