Using his current weight of 165 lbs, determine the discharge dose ...

[Wadzanai]

Using his current weight of 165 lbs, determine the discharge dose of glargine as well as an appropriate ICR for Matias to start with.
 
  What will be an ideal response?

Question 2

Matias will be started on a combination of Novolog prior to meals and snacks with glargine given in the pm. Describe the onset, peak, and duration for each of these types of insulin.
 
  What will be an ideal response?

[yahahah24021]

Answer to Question 1

 Glargine is the basal insulin, so half of the total daily insulin dose (TDD) should be from glargine. He should receive 0.3-0.5 units insulin/kg of body weight. To start, I took an average and used 0.4 units/kg body weight.
165 lbs / 2.2 = 75 kg x 0.4 units/kg = 30 units of insulin (TDD).
50 is glargine: 30 / 2 = 15 units from glargine (basal insulin).
 Algorithm for patient that has T1DM with small amount of ketones (use 0.3-0.5 units/kg).
 Insulin: carbohydrate ratio:
500 / TDD = 500 / 30 units =16.7 or 17.
This means that for every 17 g of carbohydrates ingested, Matias will need 1 unit of insulin.

Answer to Question 2

 Novolog is rapid-acting insulin, or a bolus insulin that is taken to cover the glucose ingested at meals.
Peak: When insulin is at full potential of covering glucose levels or when the highest level of insulin in the blood is reached. 30-90 minutes.
Onset: Time it takes for insulin to begin action. 5-15 minutes (rapid-acting). It begins to cover the glucose quickly, which is why it is given with meals.
Duration: How long insulin lasts in the blood. 3-5 hours.
 Glargine is long-acting or basal insulin, also known as background insulin; it covers basic functions.
Peak: None; since it is long acting, there is no peak.
Onset: 2-4 hours. This is the period of time that it takes for the insulin to begin working.
Duration: 20-24 hours. It is designed to cover the background glucose levels, which is why is it usually given at night and/or in the morning and then lasts the whole day.

[Wadzanai]

Thank you!

[yahahah24021]

Always glad to help...