Diabetes Mellitus
Definitions:

The current criteria for diagnosis include either:

Type I DM or DM1 (previously "Insulin-Dependent DM" or IDDM) is a disorder resulting from a deficiency of insulin secretion, but not in an impaired response to insulin. It tends to be diagnosed in younger patients, although it can occur at any age. It is treated with insulin.

Type II DM or DM2 (previously "Non-Insulin-Dependent DM", or NIDDM) is a disorder resulting from an impaired response to insulin, which is accompanied by an inadequate increase in insulin production. The condition is treated with diet &/or oral medications &/or insulin. Type II DM is by far the more common form. The term NIDDM was dropped because it is often incorrect - many type II diabetics require insulin to stay alive.

Complications:

Complications result primarily from damage to small vessels and to the nervous system. They include:

Insulins:

Currently available forms of insulin include:

OnsetPeakDuration of Action
Lispro (Humalog)15 Minutes1 Hour4 Hours
Regular 30-60 Minutes2-4 Hour5-7 Hours
NPH (Lente)2 Hours6-12 Hours18-28 Hours
Ultralente 4-6 Hours12-16 Hours36+ Hours
70/30 Mix 60 Minutes2-12 Hours18-28 Hours
50/50 Mix 30 Minutes2-6 Hours12-14 Hours

 

Insulin Regimens:
Enter a weight in either the Kilograms or the Pounds box (just the number, please):
Kilograms:
Pounds:
Please select what type of patient you are working with:

Newly Dx diabetic

Long-standing diabetic

Sick, or on steroids
If on TPN, enter grams of carbohydrate:
Then:
 
Or: 
When calculating total insulin requirements per day for a newly diagnosed diabetic, calculate as 0.5 units per kilogram body weight. For long-standing diabetics, use 0.6 units/Kg/day. For sick patients or patients on steroids, use 1.0 -1.2 units/Kg/day.Units of insulin per day
Of this total daily requirement, give 2/3 as NPH and 1/3 as Regular.Units NPH
Units Regular
Of those doses: Give 2/3 of the NPH in the AM and 1/2 of the Regular in the AM. Give the remaining 1/2 of the Regular before the evening meal. Give the remaining 1/3 of the NPH at bedtime.NPH in AM
Regular in AM
NPH at dinnertime
Units Regular at bedtime
If on 24hr tube feeds, calculate daily insulin as above, but give 70/30 q8hrs instead of other insulins. (1/3 of total requirement at each dose.) Remember to d/c insulin when d/c tube feeds!Units of 70/30 TID
If on TPN, give one unit Regular in the bag for every 10 grams of carbohydrate. May also need supplemental.Units of Regular insulin in the bag
Rule of 1500: Divide 1500 by the total units of insulin used daily; the resulting number represents an estimate of the amount the blood sugar will drop with each unit.mg/dL fingerstick change/unit insulin

If you must give a sliding scale, write to check glucose before each meal and at bedtime, but don’t give as much insulin at bedtime (since patient will not be eating for hours). Make sure to order 1/2 amp D50 or glucose tablets PRN for low fingersticks (<70).

Fingersticks should be QAC (before each meal) and QHS (at bedtime).

If the morning glucose is high, increase evening NPH. If lunch glucose is high, increase morning Regular. If evening stick is high, increase AM NPH. If bedtime stick is high, increase dinnertime Regular.

Using the rule of 1500 (see above), you can calculate supplemental needs. For example, if patient takes 50 units per day, 1500/50=30 - so each unit will drop FS by 30 mg/dl. So, if lunchtime stick is consistently ~ 60 mg/dL high, you can supplement morning Regular with an additional 2 units (or use 2 units Lispro at lunchtime).

For bedtime, never give Lispro - if high (>350) then give Regular based on rule of 1500 (taking into account existing Regular dosage) - be conservative at bedtime!

 

Oral Agents:

Complications result primarily from damage to small vessels and to the nervous system. They include: