Insulin doses &

regimens

Heiam BenRajab @ gemal.com

2024
TUH
 Objectives
 To know different insulin regimens.
 To identified target glycemic control.
 To know how to calculate insulin dose in different regimens.
 To know insulin therapy during steroid administration.
 Insulin regimens
The choice of insulin regimen will depend on:

 Many factors including: Type diabetes, lifestyle..

(dietary patterns, exercise schedules, work commitments etc.),
Targets of metabolic control and particularly individual patient.

 Basal-bolus insulin has the best possibility of imitating physiological

insulin profile.
 Regimens
 At least four injections of insulin per day for pregnant pt.

 Most regimens include a proportion of short (Regular) or rapid

acting insulin and intermediate-acting insulin or long acting of
basal analog.
Intensive insulin regimens to control
DM in pregnancy
 Basal bolus regimen (MDI).

 Flexible insulin therapy (Carbohydrate counting).

 Continuous subcutaneous insulin infusion. (insulin pump).

Glycemic Targets in pregnancy

Types Pre-gestational Diabetes Gestational Diabetes

Fasting ≤ 90mg /dl ≤95mg/dl

2-hr postprandial ≤120 mg/dl ≤120mg/dl

HbA1C 6.0-6.5 % recommended

 Insulin dosing guidelines during
pregnancy &postpartum
Weeks gastation Insulin TDD
1--13 weeks (0.7 x weight in Kg )
14- 26 weeks (0.8 x weight in kg)
27-37 weeks (0.9 x weigh in kg)
38 weeks to delivery (1.0 x weight in kg )
Post partum & lactation (0.55x weight in kg)

Use 50% TDD for basal insulin and 50% premeal rapid –acting insulin boluses
*Decrease nighttime basal insulin by 50% In lactating women (prevent hypoglycemia)
Patients with T1DM
10-14 weeks period of increased insulin sensitivity , insulin dosage may
need to be reduce accordingly.
14-35 weeks gestation insulin requirements typically increase steadily.
After 35weeks gestation insulin requirements may level off or even
decline.
Patients with obesity may require higher insulin dosages than those
without obesity
 CSII in pregnancy
 Benefits  Limitations
 Mimics physiologic insulin  Complexity
secretion  Requires counseling & traning .
 CSII devices use aspart or lispro  Costy
 Safe & effective for management  Potential for
of GDM, T1&T2DM  Insulin pump
 No significant difference in  User error
glycemic control for pregnancy  Infusion site problems
outcome with CSII versus MDI
therapy.
 Can help address daytime or
nocturnal hypoglycemia or a
prominent down phenomenon
 Protocol for antenatal administration
for steroids

 Admit to antenatal ward

 Inform diabetes team of admission.

Administer first dose of steroids then hourly glucose estimation by glucometer & 2
hourly midnight for 24 hours after second dose of steroids.
Antenatal intravenous insulin infusion
For patient on subcutaneous insulin increase all insulin doses by 50% 6-8
hours after the first dose of steroids.
Maintain this increase until 24hours after the second dose of steroids
For patients on diet or metformin the diabetes team can advise whether
SC insulin given.
Check urine & blood ketones if glucose above 180mg%
If blood ketones more than 1.5 mmol /l commence iv insulin.
 Insulin treatment must be started as soon as possible after diagnosis.

 If FBS in OGTT more than 120% directly start insulin .

 Whatever insulin regimen is chosen, it must be supported by
comprehensive education appropriate the individual needs.
 Daily insulin dosage varies greatly between individuals and
changes over time among stages of pregnancy.
 It therefore requires regular review and reassessment.
Improvements in glycemic control, particularly
when provided by intensive insulin treatment with
MDI or pump therapy, reduces the risks of
maternal &fetal complications.
Thanks