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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Which Titration Type Will Help In Switching From Insulin To Orals?

Hello I am in NP school, pharm class. We have case studies every week, and in this one the pt was placed insulin before orals. She is having drops in BG in the morning. Her BG is 78 at office visit, and HbA1c is 6.5. She is taking Levemir Inject 40 Units QHS Novolog 70/30 Inject 15 Units BID. I would take her off the insulin and see if orals, metformin, would work. However, I want to know a titration type schedule for switching from the insulin to orals if there is one needed?
Fri, 11 Nov 2016
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Diabetologist,  's  Response
Hello,
There is no titration schedule as such for converting form insulin to oral. Consider these points while switching to metformin
1) If the patient was put directly on insulin and is having type 2 diabetes, the insulin requirement will drastically reduce after metformin is introduced as the metformin improves insulin resistance to much extent
2) Consider stopping or reducing Novolog 70/30 to lowest possible dose. This combination contains ultrashort acting insulin also. It is better to up titrate the dose rather than facing an episode of hypoglycaemia
3) Also consider reducing the long acting Levemir dose also to certain extent, I would consider up titrating from 10-20 Units/day
4) Further adjustments in insulin dose can be done on blood glucose levels and for this constant self monitoring of blood glucose levels are also needed.
Hope the above information helps you in understanding the complexity involved and the schedule to be followed. Thanks for writing in healthcaremagic. Have a nice day.
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Which Titration Type Will Help In Switching From Insulin To Orals?

Hello, There is no titration schedule as such for converting form insulin to oral. Consider these points while switching to metformin 1) If the patient was put directly on insulin and is having type 2 diabetes, the insulin requirement will drastically reduce after metformin is introduced as the metformin improves insulin resistance to much extent 2) Consider stopping or reducing Novolog 70/30 to lowest possible dose. This combination contains ultrashort acting insulin also. It is better to up titrate the dose rather than facing an episode of hypoglycaemia 3) Also consider reducing the long acting Levemir dose also to certain extent, I would consider up titrating from 10-20 Units/day 4) Further adjustments in insulin dose can be done on blood glucose levels and for this constant self monitoring of blood glucose levels are also needed. Hope the above information helps you in understanding the complexity involved and the schedule to be followed. Thanks for writing in healthcaremagic. Have a nice day.