Insulin Initiation and Titration for Family Physicians: Case Study #2: Andy Alice Y.Y. Cheng, MD FRCPC Peter Lin, MD CCFP.

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Presentation transcript:

Insulin Initiation and Titration for Family Physicians: Case Study #2: Andy Alice Y.Y. Cheng, MD FRCPC Peter Lin, MD CCFP

Case Study #2: Andy Patient history and presentation 68 years old, retired, regimented lifestyle Type 2 diabetes for 10 years A1C = 8.2% Weight = 90 kg Maxed out on oral agents You have been discussing insulin, but he has been resistant to the idea of injections

Andy’s SMBG Logbook BreakfastLunchDinner BeforeAfterBeforeAfterBeforeAfterBedtime Sunday Monday Tuesday Wednesday Thursday10.5

Type 2 Diabetes: Insulin Choices 1. 1.Basal 2. 2.Basal plus bolus 3. 3.Pre-mixed twice daily

Why Choose Pre-mixed Insulin? Regimented/fixed lifestyle Fixed meal plan, i.e., 3 meals per day, at the same time each day Consistent physical activity regimen Blood glucose elevations throughout the day, not just in the fasting state For those who dislike multiple injections (basal + bolus regimen)

DOSING SEE REVERSE FOR TIPS CHOOSE AN INSULIN CATEGORY CHOOSE A BRAND

Pre-mixed Insulin Dosing and Titration –