Sử dụng chế độ Insulin hỗn hợp (giai đoạn 2 hoặc 3) cho bệnh nhân với các đặc điểm sau: • có phù hợp tiến độ; bữa ăn thường xuyên • 10 giờ giữa các bữa ăn sáng và ăn tối • Không chuẩn bị sẵn sàng để mất hơn 2 tiêm • Pre insulin hỗn hợp không phải là khuyến cáo ở những bệnh nhân với bệnh tiểu đường | 226 TYPE 1 DIABETES Table Selecting an Insulin Regimen Use Mixed Insulin Stage 2 or 3 regimen for patients with the following characteristics Have consistent schedule regular mealtimes 10 hours between breakfast and dinner Not prepared to take more than 2 injections Pre-mixed insulin is not recommended in patients with type 1 diabetes due to limited ability to adjust insulin Use Basal Bolus Stage 4 regimen for patients with the following characteristics Erratic or inconsistent schedule Variable carbohydrate intake 10 hours between breakfast and dinner Infrequent snacks or desire to eliminate them Shift work or frequent travel Post-meal hyperglycema physiologic release of insulin. A complete discussion of Mixed Insulin Stage 3 follows this section. See Table Insulin Stage 2 Mixed Start R N-0-R N-0 or RA N-0-RA N-0 In the absence of DKA patients with newly diagnosed type 1 diabetes should be started on insulin in the office. Initial insulin injection should be administered by the patient or family member for younger children . All patients should be started on human insulin. Determining the initial insulin dose. The total daily insulin requirement at diagnosis is a function of the current weight and urine ketones - an early sign of significant insulin deficiency and possible impending DKA - see Figure . Insulin is calculated in Units kg based on current weight. If ketones are large U kg total dose is recommended for negative to moderate ketones U kg is suggested. The total daily dose is divided into two periods roughly associated with breakfast and the evening meal approximately 10 hours apart . The pre-breakfast dose is two-thirds of the total daily requirement. This is further divided into one-third R or RA and two-thirds N. The small amount of rapid- or shortacting insulin covers breakfast. The intermediateacting insulin covers lunch and afternoon snack. Review the insulin action curves for the AM Start Insulin Stage 2 R N-0-R N-0 RA N-0-RA N-0
