Increasing The Dose of Insulin

Increasing The Dose of Insulin

It is done to overcome the loss of insulin due to excessive activity. If you are currently taking 4 injections a day and suddenly you will be offered 6 shots a day, your dose should be increased by approx 2 units per shot (for example if she takes 4-6 units for breakfast, then her dose should increase by 4-6 units for lunch and dinner). This means that there should not be any change in the total daily dosage.

The adjustment in the dose depends on the individual’s glucose levels and level of activities. The additional insulin may also cause hypoglycemia at night which can be corrected by giving 3 grams of Glucose orally or through IV route as required before bedtime.

oral hypoglycemic agents:

These reduce glucose production by the liver and increase glucose utilization in peripheral tissues. The most important side effect of these drugs is hypoglycemia (low blood sugar) but usually, they are well tolerated. Some of these drugs are glipizide, glyburide, chlorpropamide, Tolbutamide etc. This needs to be taken regularly for life because if discontinued then diabetes will recur.

Oral antidiabetic agents can cause hypoglycemia through several mechanisms including:-

1-Decreased release of stored glycogen from the liver.

2-Increased insulin sensitivity(decrease in serum insulin levels secondary to decrease in hepatic synthesis).

3-Decreased hepatic gluconeogenesis.

4-Changes in glucagon secretion and counter-regulatory hormones to increase blood sugar levels(decrease in aldosterone, growth hormone, cortisol, etc.)

Anti-diabetic drugs do not cause hypoglycemia when taken alone but may cause hypoglycemia when they are combined with other anti-diabetes drugs or insulin. Intravenous anti-diabetic agents such as insulin and glulisine can also be used to treat severe cases of hypoglycemia without causing hypoglycemia. This is usually necessary for patients who have persistent hyperinsulinism during ketosis states after TPN feeds. (glyburide can’t be given intravenously)

Oral Hypoglycemic Agents:

Reduce glucose production by the liver, increase glucose utilization in peripheral tissues. Usually, cause hypoglycemia as a side effect but can also cause other side effects such as nausea, vomiting, diarrhea, etc. Contraindicated in pregnancy and lactation. (Pregnancy could result in birth defects).

what is the average dose of insulin for type 2 diabetes:

We estimated that 7.7 million people with diabetes in the United States were prescribed insulin during 1999-2012, representing 60% of all incident users of this drug. During 1999-2012, the mean annualized cumulative dose per patient was 195 units/year (SD 159), and there were significant increases over time.

How to control blood sugar levels:

After adjustment for age, sex, education level, urbanization status, comorbidities, and baseline antihypertensive medications at index event, patients using oral agents had higher rates of stroke hospitalization compared with those using other drugs (adjusted rate ratio [ARR] = 1.35; 95% confidence interval [CI], 1.06-1.73) or no antihypertensive medications (ARR = 1.32; 95% CI, 0.96-1.81) during the shorter follow-up period, whereas those using other drugs had higher rates of coronary heart disease hospitalization compared with those using oral agents (ARR = 1.24; 95% CI, 0.99-1.55) or no antihypertensive medications (ARR = 1.29; 95% CI, 0.95-1.75).

how to adjust insulin dose in type 1 diabetes:

Background: We compared changes in insulin pump therapy with changes in insulin dose for a twice-daily basal-bolus regimen.

Conclusion: Regular adjustments in insulin doses were made to maintain specific blood glucose levels at study entry, prior to randomization.

how much time do you spend each day thinking about food:

The researchers found that overweight participants spent an average of 38 minutes per day thinking about food, while obese participants spent an average of 51.4 minutes per day on thoughts about food.

Even when the researchers controlled for dieting and disordered eating behaviors, the association between weight status and hours of thought about food was still significant. The BMI groupings were determined by calculating individuals’ body mass index (BMI) scores based on their weight and height.

insulin dose adjustment guidelines:

To avoid hypoglycemia in insulin-naïve patients, most clinical guidelines advocate gradual increases of the basal insulin dose over several weeks.

This study found that abrupt changes of insulin regimen can be made safely in adult patients with type 1 diabetes when switching from CSII to MDI, independently of starting dose or insulin sensitivity. However, larger doses compared with CSII would be required for patients with severe insulin resistance at baseline.

However, if the patient is very overweight then a higher dose is necessary to achieve target glucose levels. A new study suggests that some common methods used by doctors to determine how much insulin a diabetic patient should take are not necessarily best practices. The findings appear in the journal Diabetes Care, published by Wolters Kluwer Health.

Maximum insulin dose per day:

However, patients who started insulin during hospitalization had significantly higher mean daily dose at discharge than those who were already on insulin at admission (18.7 units/day versus 14.8 units/day, p < 0.001). Patients who received no basal insulin were less likely to receive any subsequent basal insulin compared with those starting on NPH (OR = 0.49; 95% CI, 0.28-0.84) or continuing on CSII (OR = 0.30; 95% CI, 0.19-0.47).

Maximum insulin dose per injection:

Patients in the intensive insulin therapy group had an average dose of 48 units per injection compared with 19.7 units for patients in the conventional group (P < 0.001).

Furthermore, when comparing individual trajectories, patients who were early adopters injected more than 40 mg per injection at week 12 than did later ones (P = 0.002). There was no difference in basal insulin between groups.

This study reveals that aggressive intensification beyond currently recommended levels is safe and feasible in hospitalized type 2 diabetes patients but requires adequately trained staff to ensure safety.

Intensive insulin therapy with multiple daily injections or the use of continuous subcutaneous insulin infusion may be an acceptable alternative to CSII during hospitalization if proper care is taken by trained personnel.

The minimum dose of insulin:

Conclusion: More than 1/3 of patients treated with insulin during PICU stay received doses less than recommended.

how to adjust the basal rate in an insulin pump:

Researchers found that spontaneous nighttime blood glucose excursions increased after 2 weeks of night-only insulin delivery, compared with continuous nocturnal subcutaneous insulin infusion (CSII) therapy. The investigators found no difference in the areas under the curve (AUCs) for premeal blood glucose or overall AUCs between study groups at week 8.

The overall rates of hypoglycemia did not differ significantly between groups at any time point throughout the trial; however, modestly but statistically significant decreases in mean overnight glucose concentrations were observed at both 4 and 8 weeks among patients receiving night-only insulin delivery compared with CSII.

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