International Diabetes Center International Diabetes Center Case Study #1 • 48 year old female with type 2 diabetes x 10 years • Current therapy – Metformin 1000 mg bid and Glargine 28 units at bedtime • HbA1c 7.9%; Weight 65 kg. Breakfast Breakfast Lunch Lunch Ev. Meal Ev. Meal Day Day Pre Pre Post Post Post Post Pre Pre Pre Pre Bed Bed 1 1 2 2 4 4 3 3 142 142 (7.9) (7.9) 139 139 (7.7) (7.7) 111 111 (6.2) (6.2) 124 124 (6.9) (6.9) 129 129 (7.2) (7.2) Met Met 28 G 5 132 (7.3) 196 (10.9) 184 (10.2) (10.2) 202 (11.2) (11.2) 136 (7.6) (7.6) (mmol/L) International Diabetes Center International Diabetes Center Recommendations • Continue current therapy? • Change/add oral agent? • Adjust insulin? • Add rapid acting insulin? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood glucose testing: • Target: – Blood glucose – HbA1c International Diabetes Center International Diabetes Center Case Study #2 • 64 year old female with type 2 diabetes for 6 years • Current treatment is 70/30 insulin twice per day – AM 30 units PM 18 units • Height 1.7 meters, weight 69 kg • Hypoglycemia 3x/week mid afternoon usually • HbA1c 8.2% International Diabetes Center International Diabetes Center Case Study #2 Logbook Breakfast Breakfast Lunch Lunch Ev. Meal Ev. Meal Day Day Pre Pre Post Post Post Post Pre Pre Pre Pre Bed Bed 1 1 2 2 4 4 3 3 185 185 (10.3) (10.3) 166 166 (9.2) (9.2) 179 179 (9.9) (9.9) 144 144 (8.0) (8.0) 189 189 (10.5) (10.5) 30 U 70/30 18 U 70/30 5 201 (11.2) 134 (7.4 ) 123 (6.8) (6.8) 118 (6.6) (6.6) 196 (10.9) (10.9) 62 62 218 (12.1) (12.1) 58 58 192 (10.7) 174 (9.7) 228 (12.7) 66 66 (mmol/L) International Diabetes Center International Diabetes Center Recommendations • Continue current therapy? • Add oral agent? • Adjust insulin? • Change to physiologic insulin regimen? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood glucose testing: • Target: – Blood glucose – HbA1c . Center Recommendations • Continue current therapy? • Change/add oral agent? • Adjust insulin? • Add rapid acting insulin? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood. Diabetes Center International Diabetes Center Case Study #2 • 64 year old female with type 2 diabetes for 6 years • Current treatment is 70/30 insulin twice per day – AM 30 units PM 18 units • Height. Diabetes Center Recommendations • Continue current therapy? • Add oral agent? • Adjust insulin? • Change to physiologic insulin regimen? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood