Designing An Insulin Regimen

The main goal in designing an insulin regimen is to mimic how the body normally releases insulin. If you have type 2 diabetes, there are two main ways to replace insulin. Intensive Insulin Therapy closely mimics the natural insulin production. The second, referred to as Conventional or Sliding Scale Insulin Therapy, more loosely approximates insulin needs.

For Intensive Regimens:

When you are intensively managed with insulin your medical provider will prescribe an insulin regimen for you, but these are the general principles:

You should be prescribed:

1. A basal or background insulin dose
   This will be prescribed as one or two injections of long acting insulin, or, if you are using an insulin pump, a daily infusion rate of continuous, small amounts of rapid acting insulin. The background/basal insulin dose is usually the same day to day. With an insulin pump you do have the option of temporarily changing the background rate for a few hours – up or down as needed!
2. A bolus insulin dose to cover the sugar or carbohydrate in your food
   This will be presented as an insulin to carbohydrate ratio( I:CHO). The I:CHO ratio tells you how many grams of carbohydrate can be covered by one unit of rapid acting insulin. You will need to calculate how much carbohydrate you will eat, and take a dose of insulin that matches the food.
3. A bolus insulin dose to bring your blood sugar back to the normal range
   A high blood sugar correction bolus insulin dose to bring your blood sugar back into the target range. This will be presented as a correction factor. This correction factor refers to how much your blood sugar will drop after 1 unit of insulin rapid acting insulin. When your blood sugar is too high, you will need to calculate how much your blood sugar is over the target, and, based on the correction factor, then the dose of insulin that will bring you down into the desired range.

 

For more information, please refer to the following sections:

• Calculating your insulin dose
• Intensive insulin therapy
• Insulin pump therapy

For Sliding Scale Therapy

You should be prescribed:

1. A “sliding scale” insulin dose
   The insulin dose is based on your blood sugar. The higher the blood sugar, the higher the insulin dose. – and visa versa. The lower your blood sugar, the loser the insulin dose. Sliding scale insulin regimens approximate daily insulin requirements.

Common sliding scale regimens:

• Long-acting insulin (glargine/detemir or NPH) once or twice a day with short acting insulin (Aspart, glulisine, lispro, Regular) before meals and at bedtime.
• Long-acting insulin (glargine/detemir or NPH) given once a day
• Regular and NPH given twice a day
• Pre-mixed, short-acting insulin analogs or Regular and NPH given twice a day

 

For more information, please refer to the following sections:

• Sliding Scale Therapy