Step 3 Establish the 24Hour Insulin Dosage

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Next is calculation of the approximate 24-hour insulin need. It is done on a unit-per-kilogram basis by multiplying the body weight in kilograms by a factor that takes into account the patient's tissue insulin sensitivity. Suggested conversion factors are shown in Table 4. Thus, a 28-year-old 70-kg man who bikes or plays tennis on a daily basis would be started on 21 units of insulin per day (0.3 units/kg), while a man of the same age and height with a sedentary lifestyle would receive 35 units (0.5 units/kg). Other factors, such as eating habits, are considered but in more of a qualitative way—if that inactive patient is a "big eater" (maybe not gaining weight because of the out-of-control diabetes), then a slightly higher conversion factor (0.6 units/kg) might be tried, resulting in 42 units. In contrast, pre-existing impaired renal function would result in less insulin because of the reduced insulin clearance. The same approach would be taken if there is another illness that poses a danger with hypoglycemia such as severe cardiac, cerebral, or hepatic disease. Young people (arbitrarily, less than 30 years old) with new-onset type 1 diabetes are usually given less insulin as they typically experience a rather substantial reduction in insulin needs after starting insulin therapy ("honeymoon period"); a starting insulin dosage of 0.3 units/kg is suggested. Clearly, this is an inexact science, but it is a necessary starting point for calculating the initial insulin doses. After starting, doses are adjusted based on the SBGM results. It is obviously preferable to err on the low side with the starting doses, and use the SBGM results to adjust the insulin dosages upward.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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