Estimating the Total Daily Dose (TDD) of Insulin: Weight-Based Dosing TDD in units of insulin = N x Patient's weight in Kg • Insulin Sensitive (N=0.3): Lean or malnourished patients. elderly, chronic kidney disease (stage IV or V CKD) or insulin naive • Moderate Insulin Sensitive (N=0.4): Patients without clear features of insulin sensitivity or resistance, including most type 1 diabetics • Insulin Resistant (N=0.5-1): Obese, infected/inflamed. post-surgical stress, glucocorticoids, or combination of above, including most 2 diabetics Steps to Follow: 1. Calculate TDD 2. Administer approximately 1/2 as Basal (Long-acting) and 1/2 with meals 3. Target pre-meal Blood Glucose < 140 and random Blood Glucose < 180 in non-ICU patients 4. Add sliding scale insulin for Elevated FSBS (finger stick blood sugar) Satyendra Dhar, MD @DharSaty #TDD #Insulin #dosing #estimation #Weight #Based #pharmacology #endocrinology #diabetes #DM2
