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Adding Prandial Insulin

Aug 4, 2018

Your patient has been systematically titrating his basal insulin dose for the last 6 months. His daily dose is NPH .90 U/kg/day. Despite his good efforts, you decide it would be prudent to add a prandial insulin dose to his treatment regimen. Which of the following scenarios might lead you to this conclusion?


Answer: A.  A1C=7.4%, FPG<130 mg/dl, PPG>180 mg/dl

Educational Critique: Prandial insulin administration is meant to diminish the postprandial glucose elevations. The addition of prandial insulin to a patient’s diabetes management should be considered when the glycemic target of A1C<7.0%, FPG<130 mg/dl, PPG<180 mg/dl are not being met. These targets are general and should be individualized to each patient depending on their unique needs. Basal insulin doses are generally titrated with fasting plasma glucose levels. However, as daily doses exceed .5 U/kg/day and get closer to 1.0U/kg/day, there is an increased likelihood that the addition of prandial insulin will become necessary.