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March 29, 2002

Insulin

Question from a dietitian in Milwaukee, Wisconsin, USA:

I work at an institution for the developmentally disabled, and there are not many people with diabetes here, but we have recently gotten a 20 year old woman ( 5 feet 7 inches tall, 245 pounds) with newly diagnosed type 1 diabetes, and the physicians are a little rusty on prescribing dosages. The only insulin regimen they are using is Regular and NPH. How do we calculate an insulin dose?

Answer:

Some people start with one unit of insulin per kilogram of body weight per day as a starting dose and break it up so that two-thirds is given in the morning and one-third is given before dinner. However, you have a rather large person, and the insulin resistance could be considerable. In fact, I would question whether this patient really has type 1 diabetes. Does she have type 2 diabetes at an early age?

In any case, I would start with 20-30 units per day and split it up so that two-thirds is NPH and one-third is Regular. You will have to see what kind of interval decrease in glucose you get. If no response, you know you have to increase the dose more dramatically.

It might be possible to substitute Humalog or Novolog for the short-acting regular insulin. The advantage is that they do not have to be given 30 minutes before the meal.

JTL

[Editor’s comment: One would hope that the information here might be helpful to the physicians caring for this person if they use primarily NPH and Regular, as indicated by the writer. However, there are many programs using other insulins (e.g., Lantus (insulin glargine)) that might work very well, depending on circumstances.

If it’s at all possible for the doctors to get a consultation from an endocrinologist, either formally or through what is called a “curbstone” (informal) consultation, I’d certainly lean towards doing that!

WWQ]