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Basal Bolus Insulin Calculator

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Insulin is used always in type 1 diabetics, and sometimes in type 2, or adult onset diabetes. In a type 2 diabetic we start with diet and exercise changes, then if not controlled, we add medications

Diabetes Q&a: 70/30; "rule Of Fifths"; Split-mix; Basal-bolus-- Which Is Best?: Page 2 Of 2

A: There is no one "right"method for determining the appropriate initial insulin dosage for children with new-onset type 1 diabetes (T1D). Choosing an insulin regimen often involves a trade-off between accuracy and simplicity. The split-mix regimen. Until recently, most pediatric patients with T1D were started on a "2-shot split-mix" regimen, which combined short- and long-acting insulins in a single injection given twice daily at a total daily dose of approximately 1 unit/kg. Typically, two thirds of the total daily dose was given at breakfast and one third before dinner. Two thirds of the morning dose was given as long-acting insulin (such as NPH or Lente) and one third as short-acting (such as Regular or one of the rapid-acting analogs). Half of the evening dose was given as long-acting and half as short-acting insulin. For example, for a child who weighs 36 kg, the initial insulin doses would be 8 lispro/aspart plus 16 NPH at breakfast and 6 lispro/aspart plus 6 NPH at dinner. Many clinicians are now moving away from the 2-shot split-mix regimens because they are usually insufficient to meet intensive glycemic goals without unacceptable swings in blood sugar levels. Three-shot Continue reading >>

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Popular Questions

  1. obiwan

    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards?

  2. IMtoHO

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? I could be WRONG:
    RISS- no basal given, just boluses to correct sugar qX hours.
    Correction Scale- basal given + correction boluses with first bite.

  3. jdh71

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? Use a drip in the Unit.
    For DKA just follow the algorithm found in pocket medicine. Remember initial bolus dose the rate is 0.1 Units per KG, until the GAP closes, sugars can remain high. Check K often. To reiterate . . . just follow the algorithm.
    Sliding scale is probably sort of an insulin only sugar treatment algorithm similar to what they use for the drips only in sub-q form. And the correction scale is what the nurses give to patient already on medications for anything over and above.
    After 24 hours of sub-q sliding scale insulin, you should know pretty well how much they will need in 24 hours by adding it up, let's 20 Units in 24 hours. I like to take that number and cut in half (10) and give that as long acting insulin at bedtime (glargine or glitiamer usually, whatever us formulary at your institution . . . OR if money for meds is a problem you can cut your half number in half and give as NPH AM and PM [5 and 5]), and the other half gets given as short acting aspart or regular with meals in three divided doses, ie from out current example 3 Units regular or aspart with breakfast, lunch, and dinner. The 6 am blood sugar will tell you if you need to adjust your evening glargine/glitaimer (or alternative the afternoon NPH, and the afternoon blood sugar will tell you how to adjust the morning NPH if that's th regimine you are using)
    Now, you need to hold short acting insulins for NPO status. You're not supposed to need to stop a long acting insulin like glargine or glitiamer for NPO status because these are supposed to control basal sugar metabolism, BUT you'll see people either stopping them altogether or cutting them in half for NPO status.
    Think of sulfonylureas like insulins with regard to dosing and the timing of blood sugars - these medications CAN give you hypoglycemia (some are better for liver or kidney disease, so if you have a liver or kidney patient just double check)
    Metformin is great first line for newly diagnosed DM2's especially if HgbA1c is <8. Metformin will not give you hypoglycemia (though you will run into at least one attending who will sear they've seen it). Hold these for IV contrast procedures - even though in it's current incarnation metabolic acidosis is almost unheard of, we all do it. No metformin in chronic kidney guys as a rule, but some will tolerate fine (use will probably be attending specific in this group)
    In the even of glucose (or sulfonylureal) overdose that will not respond to D50, use a glucagon drip. In these patients giving more glucose only stimulates further intrinsic insulin response. Do not panic, use the glucagon with D50.

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A short video blog from the consumerjusticegroup.com explaining the FDA drug recall process.

Roche Launches Fda-cleared Diabetes App With Insulin Calculator In Us

Last month, Roche quietly launched its Accu-Chek Connect app, a diabetes management app which contains, among other things, an unprecented feature: a prescription insulin bolus calculator called Bolus Advisor. Roche has been selling the app in other countries for a little while, even issuing a brief recall in April in some of those countries. It received FDA clearance for the Android version of the app in mid-March and finally received clearance for the iOS version in early June, using the Android clearance as the predicate device. The app gives people with diabetes a choice of reports to help identify trends and patterns in blood sugar levels and lets them share their data with their caregiver or healthcare team via connected online accounts, email or text message. It receives data from the Accu-Chek Aviva Connect Bluetooth-enabled meter. As of June 27, the app is now available in the United States for both iOS and Android devices. “The development of the Accu-Chek Connect system underscores Roche Diabetes Care’s commitment to advancing technology that empowers people with diabetes to focus on the daily wins of managing diabetes and living life as normally and actively as poss Continue reading >>

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Popular Questions

  1. obiwan

    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards?

  2. IMtoHO

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? I could be WRONG:
    RISS- no basal given, just boluses to correct sugar qX hours.
    Correction Scale- basal given + correction boluses with first bite.

  3. jdh71

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? Use a drip in the Unit.
    For DKA just follow the algorithm found in pocket medicine. Remember initial bolus dose the rate is 0.1 Units per KG, until the GAP closes, sugars can remain high. Check K often. To reiterate . . . just follow the algorithm.
    Sliding scale is probably sort of an insulin only sugar treatment algorithm similar to what they use for the drips only in sub-q form. And the correction scale is what the nurses give to patient already on medications for anything over and above.
    After 24 hours of sub-q sliding scale insulin, you should know pretty well how much they will need in 24 hours by adding it up, let's 20 Units in 24 hours. I like to take that number and cut in half (10) and give that as long acting insulin at bedtime (glargine or glitiamer usually, whatever us formulary at your institution . . . OR if money for meds is a problem you can cut your half number in half and give as NPH AM and PM [5 and 5]), and the other half gets given as short acting aspart or regular with meals in three divided doses, ie from out current example 3 Units regular or aspart with breakfast, lunch, and dinner. The 6 am blood sugar will tell you if you need to adjust your evening glargine/glitaimer (or alternative the afternoon NPH, and the afternoon blood sugar will tell you how to adjust the morning NPH if that's th regimine you are using)
    Now, you need to hold short acting insulins for NPO status. You're not supposed to need to stop a long acting insulin like glargine or glitiamer for NPO status because these are supposed to control basal sugar metabolism, BUT you'll see people either stopping them altogether or cutting them in half for NPO status.
    Think of sulfonylureas like insulins with regard to dosing and the timing of blood sugars - these medications CAN give you hypoglycemia (some are better for liver or kidney disease, so if you have a liver or kidney patient just double check)
    Metformin is great first line for newly diagnosed DM2's especially if HgbA1c is <8. Metformin will not give you hypoglycemia (though you will run into at least one attending who will sear they've seen it). Hold these for IV contrast procedures - even though in it's current incarnation metabolic acidosis is almost unheard of, we all do it. No metformin in chronic kidney guys as a rule, but some will tolerate fine (use will probably be attending specific in this group)
    In the even of glucose (or sulfonylureal) overdose that will not respond to D50, use a glucagon drip. In these patients giving more glucose only stimulates further intrinsic insulin response. Do not panic, use the glucagon with D50.

  4. -> Continue reading
read more
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What is INSULIN SHOCK THERAPY? What does INSULIN SHOCK THERAPY mean? INSULIN SHOCK THERAPY meaning - INSULIN SHOCK THERAPY definition - INSULIN SHOCK THERAPY explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s. It was one of a number of physical treatments introduced into psychiatry in the first four decades of the twentieth century. These included the convulsive therapies (cardiazol/metrazol therapy and electroconvulsive therapy), deep sleep therapy and psychosurgery. Insulin coma therapy and the convulsive therapies are collectively known as the shock therapies. Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. Patients, who were almost invariably diagnosed with schizophrenia, were selected on the basis of having a good prognosis and the physical strength to withstand an arduous treatment. There were no standard guidelines for treatment; different hospitals and psychiatrists developed their own protocols. Typically, injections were administered six days a week for about two months. The daily insulin dose was gradually increased to 100150 units until comas were produced, at which point the dose would be levelled out. Occasionally doses of up to 450 units were used. After about 50 or 60 comas, or earlier if the psychiatrist thought that maximum benefit had been achieved, the dose of insulin was rapidly reduced before treatment was stopped. Courses of up to 2 years have been documented. After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness. Sopor and comaif the dose was high enoughwould follow. Each coma would last for up to an hour and be terminated by intravenous glucose. Seizures sometimes occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around. Some psychiatrists regarded seizures as therapeutic and patients were sometimes also given electroconvulsive therapy or cardiazol/metrazol convulsive therapy during the coma, or on the day of the week when they didnt have insulin treatment. When they were not in a coma, insulin coma patients were kept together in a group and given special treatment and attention; one handbook for psychiatric nurses, written by British psychiatrist Eric Cunningham Dax, instructs nurses to take their insulin patients out walking and occupy them with games and competitions, flower-picking and map-reading, etc. Patients required continuous supervision as there was a danger of hypoglycemic aftershocks after the coma. In "modified insulin therapy", used in the treatment of neurosis, patients were given lower (sub-coma) doses of insulin. A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80 percent in the treatment of schizophrenia; a few others argued that it merely sped up remission in those patients who would undergo remission anyway. The consensus at the time was somewhere in between - claiming a success rate of about 50 percent in patients who had been ill for less than a year (about double the spontaneous remission rate) with no influence on relapse. Sakel suggested the therapy worked by "causing an intensification of the tonus of the parasympathetic end of the autonomic nervous system, by blockading the nerve cell, and by strengthening the anabolic force which induces the restoration of the normal function of the nerve cell and the recovery of the patient." The shock therapies in general had developed on the erroneous premise that epilepsy and schizophrenia rarely occurred in the same patient. Another theory was that patients were somehow "jolted" out of their mental illness.

Insulin Therapy For Challenging Patient Cases

Initiating and advancing insulin therapy in patients with type 2 diabetes mellitus can be challenging. However, with the availability of insulin analogs with more physiologic profiles, and with the initiation of simple insulin regimens (eg, the use of basal insulin administered once daily), an opportunity is created to empower patients to self-titrate their insulin. Self-titration can reduce the burden on the physician as well as improve glycemic control in patients. More options for intensifying insulin now exist, including gradually adding prandial insulin (referred to as a basal “plus” strategy) or using premixed insulin analogs for patients with relatively consistent lifestyles and habits. More-concentrated forms of insulin, such as U-500 insulin, may be helpful for patients requiring very large doses of insulin. The key is to match the insulin regimen to the patient; engage in dialogue to understand the patient's lifestyle, concerns, and skill sets; and develop, through a shared decision-making process, appropriate individualized treatment recommendations. The present review article focuses on the use of insulin replacement therapy in challenging patient cases. Approximate Continue reading >>

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Popular Questions

  1. obiwan

    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards?

  2. IMtoHO

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? I could be WRONG:
    RISS- no basal given, just boluses to correct sugar qX hours.
    Correction Scale- basal given + correction boluses with first bite.

  3. jdh71

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? Use a drip in the Unit.
    For DKA just follow the algorithm found in pocket medicine. Remember initial bolus dose the rate is 0.1 Units per KG, until the GAP closes, sugars can remain high. Check K often. To reiterate . . . just follow the algorithm.
    Sliding scale is probably sort of an insulin only sugar treatment algorithm similar to what they use for the drips only in sub-q form. And the correction scale is what the nurses give to patient already on medications for anything over and above.
    After 24 hours of sub-q sliding scale insulin, you should know pretty well how much they will need in 24 hours by adding it up, let's 20 Units in 24 hours. I like to take that number and cut in half (10) and give that as long acting insulin at bedtime (glargine or glitiamer usually, whatever us formulary at your institution . . . OR if money for meds is a problem you can cut your half number in half and give as NPH AM and PM [5 and 5]), and the other half gets given as short acting aspart or regular with meals in three divided doses, ie from out current example 3 Units regular or aspart with breakfast, lunch, and dinner. The 6 am blood sugar will tell you if you need to adjust your evening glargine/glitaimer (or alternative the afternoon NPH, and the afternoon blood sugar will tell you how to adjust the morning NPH if that's th regimine you are using)
    Now, you need to hold short acting insulins for NPO status. You're not supposed to need to stop a long acting insulin like glargine or glitiamer for NPO status because these are supposed to control basal sugar metabolism, BUT you'll see people either stopping them altogether or cutting them in half for NPO status.
    Think of sulfonylureas like insulins with regard to dosing and the timing of blood sugars - these medications CAN give you hypoglycemia (some are better for liver or kidney disease, so if you have a liver or kidney patient just double check)
    Metformin is great first line for newly diagnosed DM2's especially if HgbA1c is <8. Metformin will not give you hypoglycemia (though you will run into at least one attending who will sear they've seen it). Hold these for IV contrast procedures - even though in it's current incarnation metabolic acidosis is almost unheard of, we all do it. No metformin in chronic kidney guys as a rule, but some will tolerate fine (use will probably be attending specific in this group)
    In the even of glucose (or sulfonylureal) overdose that will not respond to D50, use a glucagon drip. In these patients giving more glucose only stimulates further intrinsic insulin response. Do not panic, use the glucagon with D50.

  4. -> Continue reading
read more

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