Designing An Insulin Regimen in Type 2 Diabetes

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:

Your medical provider may prescribe:

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:C). The I:C 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 above target blood sugar back to the normal range
   This will be presented as an insulin sensitivity factor (ISF) or correction factor. This ISF 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 insulin sensitivity factor, then the dose of insulin that will bring you down into the desired range.

Common intensive regimens for Type 2 Diabetes:

• Long-acting insulin (glargine/detemir/degludec/NPH) once or twice a day with rapid acting insulin (aspart, glulisine, lispro) before meals and as need to correct high blood sugars.
• Rapid acting insulin (aspart, glulisine, lispro) delivered via an insulin pump.
• Short acting insulin (regular) delivered with meals as multiple daily injections.

For more information, please refer to the following sections:

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

For Sliding Scale Therapy

You medical provider may prescribe:

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/NPH) once or twice a day with short acting insulin (aspart, glulisine, lispro, regular) before meals and at bedtime.
• Long-acting insulin (glargine/detemir/degludec/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

***below are pictures only***need to sort source

For more information, please refer to the following sections: