 |
Insulin Adjustment for patients on
sulphonylureas and basal insulin regime (+/-
Metformin as tolerated) |
Changing from oral agents to insulin
- Once established on insulin, target HbA1c remains <7%
- Patients should have review of options for food and lifestyle modification
(pre-insulin assessment)
- Patients taking rosiglitazone should have this discontinued when starting
insulin
- Patients taking rosiglitazone and metformin or sulphonylurea as dual therapy
should restart sulphonylurea and maximal tolerated metformin when starting once
daily insulin
Initial Insulatard regime at tea or bedtime
- Continue sulphonylurea and Metformin (as tolerated)
- Start Insulatard 10 units at tea or bedtime
- Adjust dose daily to achieve fasting glucose 4-9mmol/L
When to start additional morning insulatard
- Start morning insulin if fasting glucose 4-9 mmol/L but tea-time glucose
>10mmol/L
- At this point stop sulphonylurea treatment but continue metformin
When to switch to Mixtard instead of Insulatard
- Start Mixtard in the morning if
tea-time blood glucose 4-9 mmol/L but lunchtime glucose >10mmol/L
- Start Mixtard in the evening if
fasting blood glucose 4-9 mmol/L but bedtime glucose >9mmol/L
When daily insulin dose is >40u/day, consider
- Stop sulphonylurea (assume pancreas now no longer producing insulin)
- Convert to bd Mixtard (if not already on this)
- Doses AM and PM determined by blood glucose profile and insulin doses
See relevant protocols for:
Source: Northumbria NHS Health Care Trust diabetes protocol