Insulin

Question 1

Insulin:

What is the average Pre-prandial blood Glucose (av prepBG) level?

Answer 1

mean of the mane/middi/nocte preprandial blood glucose level

eg. 5+7+8/3 = 6.6mmol/L

Question 2

Insulin:

How to check accurate correlation between HbA1c and av prepBG?

Answer 2

av prepBG ~ (2xHbA1c) - 7
eg. HbA1c = 8% therefore (2x8) - 7 = est. av prepBG of 9mmol/L
If calculate av prepBG is above or below this the question needs to be asked is why?

Question 3

Insulin:

Approach to insulin management and initiation?

Answer 3

1) Ensure that fasting BGL trend is consistent (if not then a Diabetic educator review is required)
2) Fix the fasting BGL with nocte basal insulin
3) fix the evening prepandial BGL (if required with mane basal insulin - needed in 10 - 20%)
4) look for unaccounted for hyperglycaemia (by comparing HbA1c % to av prepBG’s)