Abstract
Introduction: Type 2 diabetes is a progressive disease with a significant risk for developing late complications. Objectives: This study aimed to determine if the discharge NPH and regular insulin doses of conventional insulin therapy protocol in which optimal glycemic control can be achieved are similar to NPH and regular insulin doses at beginning of the insulin protocol or not. In other words, we aimed to compare two insulin injection methods on the control of type 2 diabetes. Patients and Methods: This cross-sectional study was performed on hospital records of type II diabetic patients admitted for insulin therapy with the conventional protocol from 2008-2013. Treatment was initiated with the following proportions; morning NPH: 44%, morning regular dosage: 22%, evening NPH dosage: 17% and evening regular dosage: 17%. Insulin doses of the discharge day in which optimal glycemic control has been achieved were recorded and based on their mean, a protocol was made. Finally, two groups were categorized. Group 1 consisted of patients whose discharge insulin dose was in the range of the mean data of the study (±2 IU/mL) and patients whose discharge insulin dose was in accordance with the conventional protocol (±2 IU/mL) participated in group 2. Results: At discharge day, the mean morning NPH dose was 34.2±6.69, morning regular: 23.8±6.36, evening NPH: 21.26±6.75 and evening regular: 20.74±5.51. The discharge insulin ratios of the conventional protocol were similar to that of the admission ratios in only 17.7% of the patients. Only 34.5% of the patients could include in the new protocol and 50% of them didn’t fit any protocol. Conclusion: It is suggested to inject one-third of the total daily insulin need as NPH in the morning and divide the remained two-thirds between morning regular, evening NPH and evening regular equally. This may decrease the length of hospital stay and decrease the time to reach the desired glycemic control.
Highlights
Type 2 diabetes is a progressive disease with a significant risk for developing late complications
Group 1 consisted of patients whose discharge insulin dose was in the range of the mean data of the study (±2 IU/mL) were called “in accordance with the mean” and patients whose discharge insulin dose was in accordance with the conventional protocol (±2 IU/mL) were placed in group 2
Fifty-two (23.6%) patients had evening NPH between 15-19% and evening regular 15-17% was observed in 51(23.2%) cases
Summary
Type 2 diabetes is a progressive disease with a significant risk for developing late complications. Insulin doses of the discharge day in which optimal glycemic control has been achieved were recorded and based on their mean, a protocol was made. Conclusion: It is suggested to inject one-third of the total daily insulin need as NPH in the morning and divide the remained two-thirds between morning regular, evening NPH and evening regular . This may decrease the length of hospital stay and decrease the time to reach the desired glycemic control. Conventional insulin therapy (1/3-2/3) is one of the most common protocols in which the total daily insulin need of the patient is calculated based on body weight (0.3-0.5 mg/kg). NPH and the regular ratio are modified to reach glycemic glucose (if FBS is high, evening NPH increases and if 2-hour postprandial (2hpp) is high, mornings regular is increased) [7]
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