Assuming she is on maximum metformin, glyburide, and acarbose, I would
start with bedtime long acting insulin eg lente or Humulin N at about 8-10
units, and reduce the sulphonylurea by 50%, and leave the other oral
agents as is.
Mark Joyce, M.D. Tel:(4O3)239-3231
47 Crowfoot Way NW Fax:(4O3)239-3234
Calgary Alberta T3L 1X5 Canada Email:[log in to unmask]
On Fri, 20 Feb 1998, Joe Gallagher wrote:
>
> 75 year old Diabetic woman with secondary failure. On max therapy and
> diet but for the past few months sugars vary from 15 to 25. I referred
> her to local hospital to put her on Insulin. They diddered and sent her
> to the dietician. Since they have reneged I will take the decision and
> start her on Insulin. ( lives with son who would administer).
> I seem to remember this type of patient does well on a single dose of
> Actrapid. Is this so? What dose and is there a consensus.
> One time I used to look in a book but I now take the lazy option and ask
> my highly intelligent and erudite colleagues. Oh yes I also ask the
> GP-UK list. :-)
>
>
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