Insulin Regimen

Is it advisable to go unconventional in insulin ? Premix in morning and glargine at bedtime Kindly give your views

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The purpose of long acting insulin is to control baseline blood sugar, in real life it represents fasting blood sugar The purpose of short acting insulin is to control post prandial blood sugar Combination of Glargine insulin with premixed insulin need not be done just for sake of using a combination The thought process need to be directed to - which blood sugar is targeted and which insulin is used for it For example - if fasting blood sugar if 200 mg/dl then Glargine insulin is added or if it is already in use then dose is increased But if fasting blood sugar if 110 mg/dl which is normal and post lunch blood sugar is 250 mg/dl which is high, then, in this scenario, there is no scope for increasing basal Glargine insulin, because fasting sugar is normal. Further increase in Glargine insulin will cause hypoglycemia in morning. Therefore, the only choice to control post prandial blood sugar is to add short acting insulin before meal Remember - premixed insulin is used for convenience of single injection containing both short and long acting insulin so single prick -but it need not be the best choice of insulin, it has several limitations - such as when dose of premixed insulin is increased - by default there is increase in dose of long as well as short acting insulin - there are situation in life when you want to increase dose of one of these insulin but do not want to increase the dose of other insulin

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There is nothing like unconventional. If someone is having high FPG, post breakfast PG & post lunch PG but experience hypoglycemia on night dose of premix, then this regimen which you're showing here is the right choice of treatment in this particular case. Premix is a mixture of short & intermediate acting insulin which will take care of breakfast & lunchtime glucose surge and IGlar will take care of the basal & fasting. The sole aim of our treatment is to keep the PWD within TIR without causing hypoglycemia.

Valuable opinion
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Every thing depends on islet cell reserve, and how carefully patient follows diet and exercise. Once a day glargine with Actrapid has been found to be effective in moderate cases. Once daily Mixtard with once daily glargine insulin should take care of basal need and post prandial surge of one main meal. Metformin should be the basic OHA. If need be gliptins can be added.

I don't have any authantic document nor posted by you to validate the authenticity of this ...With reference to conditional or unconditionally safe. Sorry I just can not comment. Leading diabetologists of the forum can speak more about.

Yes,off course,u can do it..