intensive insulin therapy

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insulin therapy www.diabetesclinic.ca * intensive insulin therapy www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * objectives optimize diabetes management assist you in initiating insulin in your office when to start insulin therapy? insulins, doses, delivery options patient training www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * the objective of this presentation is to assist you in optimizing the management of type 2 diabetes by initiating insulin treatment in your office. the goal is to help you identify those patients that are candidates for insulin treatment as well as help you get them started. specifically, when to start insulin, what insulin to prescribe and at what dose, the various insulin delivery options and patient training. why is this important? because of the sheer number of patients relative to the number of endocrinologists. www.diabetesclinic.ca * challenges in initiating insulin? 1. patient attitudes fear of needles insulin viewed as a threat …

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t therapy. insulin is another tool to use for blood glucose control and should not be viewed as a last resort when all else fails. www.diabetesclinic.ca * type 1 diabetes: impaired or absent ß cell function:  insulin secretion normal insulin action:  insulin sensitivity the insulin deficiency results in unacceptable blood glucose control www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * type 2 diabetes: double impairment impaired ß cell function:  insulin secretion impaired insulin action:  insulin resistance results in unacceptable blood glucose control www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * type 1 & 2 diabetes: key concepts minimizing the complications of diabetes requires: early diagnosis and treatment of diabetes maintaining hba1c level < 7% achieving hba1c < 7% requires control of post-prandial and fasting hyperglycemia www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * they key concepts in type 2 diabetes are (1) …

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emia diet counseling with exercise component diabetes education for every patient pharmacological treatment; oral and insulin www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * patient counselling topics a.review symptoms and treatment of hypoglycemia b.proper training and correct use of glucose monitor c.target desired glycemic levels for each patient www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * there are three key topics that you should discuss with your patients. hypoglycemia: a key part in patient counselling is getting patients to recognize the signs and symptoms of hypoglycemia and even more importantly to prevent it. glucose monitor: patient should also be taught how to properly use a glucose monitor. if they feel comfortable using a glucose monitor, then this will help increase the likelihood of testing. glycemic control: it is also important that you identify for each patients the desired glycemic levels. let ’s address hypoglycemia more in detail. www.diabetesclinic.ca …

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nic.ca * preventing hypoglycemia check bg 4-6 times per day carry glucose tablets have glucagon kit available www.diabetesclinic.ca www.diabetesclinic.ca * preventing hypoglycemia test before driving and ideally 1 hour later (target: over 5.5 mmol/l) perform two smbg 30 minutes apart prior to bedtime (confirming rising or falling bg) when drinking alcohol, perform smbg hourly with exercise, perform smbg pre- and post-exercise if hypoglycemia episodes persist, raise target glucose levels www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * hypoglycemia treatment guidelines the rule of 15 if bg is 4 mmol/l or below treat with 15 grams of carbohydrates (glucose tabs) check bg in 15 minutes, and if not above 4 mmol/l, repeat treatment glucagon current emergency kit readily available and knowledgeable person trained to administer www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * preventing hyperglycemia and dka monitor bg 4-6 times per day use correction boluses when …

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e prescribed by the attending physician to improve patient safety and increase motivation to comply with treatment www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * there are several good reasons why it is important for patients to monitor their blood glucose. note to speaker: use a log book with entries to demonstrate potential adjustments to the insulin dose. www.diabetesclinic.ca * ideal testing frequency stable type 2 1-2 readings/day type 1 or unstable type 2 3-8 readings/day important to stress the need to vary testing times ac, pc, h.s. and prn during the night www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * injection tools and options durable delivery devices novolin-pen® 3 novolin-pen® junior induo® innovo® humapen® insulin pumps syringes disposable: multidose, prefilled (3.0 ml) novolinset® (nph, toronto, 30/70 ) humulin® n www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * advancing insulin therapy through device innovation www.diabetesclinic.ca j.robin …

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insulin therapy www.diabetesclinic.ca * intensive insulin therapy www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * www.diabetesclinic.ca * objectives optimize diabetes management assist you in initiating insulin in your office when to start insulin therapy? insulins, doses, delivery options patient training www.diabetesclinic.ca j.robin conway m.d. j.robin conway m.d. * the objective of this presentation is to assist you in optimizing the management of type 2 diabetes by initiating insulin treatment in your office. the goal is to help you identify those patients that are candidates for insulin treatment as well as help you get them started. specifically, when to start insulin, what insulin to prescribe and at what dose, the various insulin delivery options and patient traini...

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