case studies insulin start and administratrion

International Diabetes Center International Diabetes Center Case Study #1 • 48 year old female • Type 2 diabetes for 10 years • Current therapy: Combination Oral Agent (metformin 1000 mg bid and glimeperide 6 mg/day) • Height 1.6 meters Weight 68 kg. • Blood pressure 128/82 mmHg • HbA1c 8.7% • Targets: HbA1c < 7% Fasting/Pre-meal BG 70-140 mg/dL (3.9-7.7 mmol/L) International Diabetes Center International Diabetes Center 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 3 179 179 (9.9) (9.9) 189 189 (10.5) (10.5) 206 206 (11.4) (11.4) 198 198 (11.0) (11.0) 147 147 (8.2) (8.2) 139 139 (7.7) (7.7) 142 142 (7.9) (7.9) 160 160 (8.9) (8.9) Met Glim Met Glim Case #1 Log Book Met = metformin Glim = glimeperide (mmol/L) International Diabetes Center International Diabetes Center Recommendations • What therapy would you recommend? – Continue current therapy? – Change diet only? – Start Combination Oral Agent/Insulin therapy? – Start insulin and stop oral agent? • Why? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood glucose testing: • Target: – Blood glucose – HbA1c International Diabetes Center International Diabetes Center Case #2 • 45 year old executive male newly diagnosed with type 2 diabetes • HbA1c 13%; BG in office 20.3 mmol/L (366 mg/dL) • Symptoms: fatigue, polyuria, nocturia • Urine ketones negative • Height 1.7 meters; weight 74 kg International Diabetes Center International Diabetes Center Recommendations • What therapy would you start? – Medical Nutrition Therapy? – Oral Agent? – Combination Oral Agent? – Insulin? • Why? International Diabetes Center International Diabetes Center Orders • Medication: • Dose: • Timing: • Blood glucose testing: • Target: – Blood glucose – HbA1c . you recommend? – Continue current therapy? – Change diet only? – Start Combination Oral Agent /Insulin therapy? – Start insulin and stop oral agent? • Why? International Diabetes Center International. Center International Diabetes Center Case Study #1 • 48 year old female • Type 2 diabetes for 10 years • Current therapy: Combination Oral Agent (metformin 1000 mg bid and glimeperide 6 mg/day) • Height. Diabetes Center Recommendations • What therapy would you start? – Medical Nutrition Therapy? – Oral Agent? – Combination Oral Agent? – Insulin? • Why? International Diabetes Center International