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Table 7 Adjustment of insulin therapy

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

Rapid-acting insulin

Long-lasting basal insulin

3 methods for adjusting rapid-acting insulin

 

Retrospective ( sliding scale ) - the simplest- given dose according to pre-prandial blood glucose

Anticipatory

Functional

Only when pre-prandial glucose >1.20 g/L or when the patient loses weight

- insulin dose according to postprandial glycaemia observed at the same time on preceding days.

- insulin dose based on counting carbohydrates - complex

- usually 2 detemir injections

- or a single glargine injection in the evening at a total dose of 0.3 to 0.5 U/kg/day.

- more complex to use but

- poorly suited to transient insulin therapy

- Any increase in pre-prandial glycaemia (particularly in the morning) >1.50 g/L necessitates an increase of 2 to 4 units in the dose of slow-acting insulin relative to the previous day.

- more appropriate if steroids use