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yes! She should have already been on orals, unless otherwise contraindicated.
I usually start Metformin 500 ER in the am with breakfast, titrating every few weeks, then add Glyburide, again, slowly titrating. As long as they don't have any renal or hepatic issues, your golden.
This may reduce your need for Lantus bid, although, I doubt entirely with glucoses that high
Hello I have a DMII patient who is on Lantus 50 Units BID. Her Blood suger is 400-500. She refused to go to endocrin specialist. I want to start NPH but I dont know how much I have to start with . I know 0.5 units per kilogram but the patient is already on Lantus and I dont know if I need to add full dose or portion of dose that I calculated for NPH. I appreciate your comments and feedback.
A good rule of thumb is that the lantus should be ONLY the basal rate the pancreas would produce (half of daily insulin used) and then the rest should be "nutritional" coverage (short acting insulin with meals). 50% of total daily insulin should be nutritional, 50% lantus. In practice I do not add a sulfonylurea to insulin because I have admitted too many people who have been hypoglycemic with the combination. I will add metformin though. I avoid TZDs all together.
An online forum should not be the place to get advice about how to treat specific patients. Curbside or consult an endocrinologist or ask one of the docs around you.
NPRoseMona
21 Posts
Hello I have a DMII patient who is on Lantus 50 Units BID. Her Blood suger is 400-500. She refused to go to endocrin specialist. I want to start NPH but I dont know how much I have to start with . I know 0.5 units per kilogram but the patient is already on Lantus and I dont know if I need to add full dose or portion of dose that I calculated for NPH. I appreciate your comments and feedback.