Diabetes

Published

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.

Up Vote Up Vote ×
Specializes in Emergency, MCCU, Surgical/ENT, Hep Trans.

I have noticed from the Endo's at my hospital, they seem to be leaning toward rapid acting pre-meal insulin, e.g. Aspart/Apidra/Lispro for these folks. As well, is he/she still on orals as well?

C-peptide/insulin labs?

Up Vote Up Vote ×

no she is not on oral at all only 50 units lanuts am and 50 pm. Can we add oral pill when patient is already on lantus?

Up Vote Up Vote ×
Specializes in ICU, ER, OR, FNP.

if people are smart - i really like lantus with coverage. lantus is really just like your basal rate pancreas activity and the coverage of course mimics postprandial blast of insulin. also, look at the graph for lantus onset and duration; it really doesn’t have any huge spikes like nph.

a297ecd93c3a31171ea0d8f3b2320821.gif

Up Vote Up Vote ×
Specializes in Emergency, MCCU, Surgical/ENT, Hep Trans.

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

Up Vote Up Vote ×

Her primary doctor dc/d all her orals. Now I want to start NPH and I dont know when pt is on lantus 100 units daily how much NPH I have to add? 0.5 units per Kilogram/daily or a portion of it because she is already taking Lantus?

Up Vote Up Vote ×
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.

Up Vote Up Vote ×
Specializes in allergy and asthma, urgent care.

If the patient is willing to test 4 times a day I would go with sliding scale short acting before meals.

Up Vote Up Vote ×
+ Join the Discussion