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For blood sugar over 150 mg/dl PLUS moderate to large ketones in the urine , add 20% of your total daily dose as Regular insulin every 4-6 hours.
Example: Blood sugar is 300 mg, urine ketones - positive.
20% of the total dose = 6 units.
Add 6 units regular insulin to usual dose every 4-6 hours, when blood sugar is over 150 mg and urine ketones are positive.
Total usual AM dose of insulin
14 units 2 units
Total usual PM dose of insulin
Total usual bedtime dose of insulin
The DCCT is a clinical study conducted from 1983 to 1993 by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes. NEJM 342:381-389, 2000 DCCT Study Findings Lowering blood glucose reduces risk: Eye disease 76% reduced risk Kidney disease 50% reduced risk Nerve disease 60% reduced risk
RS is a 12 yr old female with T1 DM for 6 yrs. A1C = 7.3, insulin dose is AM: 8 Reg / 18 NPH; Dinner: 7Reg; HS: 20 NPH. BGs
Continuous Glucose Monitor - Overnight Unsuspected and Asymptomatic Hypoglycemia – Common up to 85% of episodes are nocturnal
T2 DM vs T1 DM T2 DM T1 DM Obesity 95% > 85%tile Not Common + Family Hx T2 72 – 85% Not Common Acanthosis Nigricans 60 – 86% 7% all school aged children Maternal Gestational DM + Not Common IUGR + Not common
Pathophysiology of T2 DM Multifactorial Disease
50 – 90% concordance
AD Single gene 4q
Susceptibility locus 2
African Americans 30% less insulin sensitive than Caucasians
High fat CHO diet
Mean age of onset = 13 yr
30% higher insulin requirement in puberty
Decline in insulin
“ glucose toxicity”
Impaired insulin sensitivity high insulin levels reduced GLUT-1 transporter