U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Tuesday, September 30, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


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Type 2 Diabetes and Insulin

Type 2 Diabetes and Insulin Algorithm Card
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NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

Steps in Insulin Management

Step 1: Target FPG with basal insulin

  • Goal for FPG is 70 to 130 mg/dL.*
  • Start with a bedtime dose of basal insulin 10 units (or 0.2 units/kg body weight). Increase the dose by 2 units every 3 days until FPG is 70 to 130 mg/dL.*
  • The dose maybe increased by 4 units every 3 days if FPG is >180 mg/dL.*

Step 2: Target premeal glucose, one target at a time.

  • Target goal for premeal glucose is between 70 – 130 mg/dL.*
  • If pre-lunch glucose is >130 mg/dL*, start 4 units of Bolus insulin before breakfast.
  • If pre-supper glucose is >130 mg/L*, start 4 units of Bolus insulin before lunch OR add or increase morning NPH/levemir.
  • If bedtime glucose is above target (e.g. >140 mg/dL*), start 4 units of Bolus insulin before supper OR Increase evening NPH/levemir.
  • Increase Bolus insulin by 2 units every 3 days.
  • As insulin doses get larger (over 10 units), begin to change insulin dose by 10 to 20%.

Step 3: Target postprandial glucose

  • If A1C is not at goal, target the post-prandial glucose with Bolus premeal insulin. The 2 hour post-prandial glucose target is <160 mg/dL to 180 mg/dL.*

*Note: Glucose targets should be individualized based on patient comorbidities, needs and response to blood glucose lowering

References:

Nathan, DM. et. al. Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy. Exit Disclaimer: You Are Leaving www.ihs.gov Diabetes Care 2009; 32:193–203.

Podcast on insulin management available by Richard M Bergenstal, MD. Podcast

 
Overview How To Other Resources

Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov