Two doctors discuss how to Rx insulin, and what they really do know about medicine they try to discuss? well, let us start from the beginning:
To chose what dose of insulin to inject it is diabetic must select how many units to put into belly. But when it is vials or pens, it is so important that only doctor will choose. What doctor think about dose of insulin how to find it how many units to inject? It must be in Rx, no any way around. If doctor said, use as directed Rx would be back to doctor. So, what doctor Rx to patient?
So, the first it is 6 units of insulin per meal. (150:50=3; 3*2=6 units.)
Now, What is the level of sugar when patient needs 20 units of insulin every meal? As I do remember so far, diabetes is pancreas disorder, insufficient insulin secretion. How this secretion related with amount of daily meals?
And also, when it is max amount of units for each 50 mg/dl, then how high level of sugar is it?
18:2 =9 for 50 * 9 = 450 mg/dl, if I am correct, right? So, the question is, what is the level of sugar would be if patient take 2 units for 50 mg/dl? 500 mg/dl. And for this level of sugar patient have to take how many units of insulin? It is 18 units for 450 mg/dl, and how many units for 150 mg/dl? To records if doctors do not know it in hospitals there is no one unit of insulin if patient has less the 200 mg/dl.
Still, it is not clear, how doctor Rx dose of insulin? Really, what if 150 mg/dl ia resulted by 300 units of insulin daily dose? So, for every 50 mg/dl I have to add 2 units? Then 300 units of insulin come from where? Math is good, but it does not do the job for insulin prescription. Sorry, doctors. You are too low in diabetes understanding. Better do not show up on public with your so naive like Old Wive medical education. Shame of you!!!!!!!!!!!!!
Covering All the Bases When Prescribing Insulin: A Detailed 'How To'
Dr Pfotenhauer: One of the first things that you have to consider after picking an insulin is what the dose of the insulin is going to be.Right? Wrong. At first doctor have to find out which type of insulin to Rx, and depending on the type of insulin dose of injection will be. Novolog is short acting type of insulin, and it is Rx in small dose. Personally I took never higher then 25 units, and usually it is less then 20. In contrary, Lantus Solo Star is long acting insulin, slow release type of insulin. I take 300 units of this type of insulin daily. This is why type of insulin must be the first thing to consider, rather then dose of it.
You have to think about the concentration of the insulin that you are using and whether it is dosed in a pen or a vial. For instance, if a patient is taking 10 U in the evening, we know that pens contain 100 U/mL, and there are 3 mL in each pen. If your patient is using 10 U in the evening, the monthly dose is calculated at about 300 U, which would be 1 pen for the month. Similarly, for vials, we could do the same thing, but vials have 10 mL instead of 3 mL; we want to calculate that dose either by 1 month or by 3 months. Just getting used to and getting more comfortable with doing that math is really important as physicians.Right? Wrong. There are nothing about dose of insulin doctor must Rx. According to doctor's Rx the injection of amount of units will be taken by patient. It is not about how many units in pen or in vial, it is about how dose of insulin will control blood sugar in diabetic's body. If dose is too low, then diabetes will progress. If dose of insulin is too high diabetic can skip into coma with low blood sugar. Looks like both doctors discuss all bout they have no one idea, but the Sum $$$$$ will be deposited on their account. At least they must be better educated before stand in front of public as educators.
Dr Shubrook: So first you pick an insulin, then you pick a pen or vial, and then you pick the dose to know how much you will need. What other things need to be considered for that prescription?Right Dr. Shubrook. You are better to know something about insulin.
Dr Pfotenhauer: You need to include several things, including the concentration of the insulin, the dose the patient is going to take, and how the patient is going to take it—for example, inject subcutaneously. It is also important to include the diagnosis on the script for insurance purposes.Dear Dr Pfotenhauer, it is you who Rx insulin, not patient who is going to take is as one wish. It is your duty to educate patient how to use pen or vial, and it is you who Rx dose of insulin for daily injections, not patient who must find it riding to high/low swings every day. Well, of cause it is important to include diagnose what type of diabetes, or if patient diabetic or not. Why really it is only for insurance? At least patient must know why needle go into belly every day. BTW, how many times daily injections must be? Do you take this into consideration? At least but not last, how patient going to take insulin? Is there some options for administration? I never knew that insulin can be taken in any way but injected subcutaneously.
Dr Pfotenhauer: Absolutely. The pharmacist will need to know what insulin to fill. I will put the concentration of the dose and then the number of pens or vials to be dispensed.If I did not take insulin in daily pattern, I would be very confused and really misunderstood that pharmacy has choice to fill concentration of insulin. But I do know about insulin a little bit more then this one who pretend to be a doctor and who really has right to give to me Rx to insulin. For the record, no one doctor chose concentration of insulin. No one pharmacy do it. It is all in the type of insulin, so, as I said, the type of insulin must be first in selection and consideration. Also for the education of our educator, there is no difference in dose according to the concentration of insulin in pen or vial. The dose of injection is the same U-100, U- 200, or U-500.
Dr Shubrook: We have to think about a lot of things. We need to include a diagnosis, the daily insulin dose, the time for administration, whether vials or pens should be dispensed, and how many vials or pens we are writing for.Sorry, Dr Shubrook. There are a lot of work which done by pharmacy and manufacture company. Pharmacy will calculate how many pens diabetic need for how many days. In paper that accompany medicine we all time do have the number days for which this delivery done. Also usually pharmacy call to remind that Rx is ready to re-fill. Doctors do not do this job. On pharmacy label there are data when this medicine must be discharged. Really, why two of you do not know basic in the subject you two discuss?
Dr Pfotenhauer: Correct. As you do it more often, it becomes a little bit easier knowing that there are 300 U per pen, so you can calculate a monthly dose easily, and five pens per box. You can also write in the number of boxes vs the number of total insulin units.Sorry, the point is what? How do you calculate monthly dose of insulin? Really, dose of insulin does not depend from amount of units in pen, or amount of pens in box, don't you know it? Why do you so ..... simple?
Dr Shubrook: You have hit so many important points today. To review, when writing for insulin, choose between vials and pens.Brilliant!!!!!!!!!!
To chose what dose of insulin to inject it is diabetic must select how many units to put into belly. But when it is vials or pens, it is so important that only doctor will choose. What doctor think about dose of insulin how to find it how many units to inject? It must be in Rx, no any way around. If doctor said, use as directed Rx would be back to doctor. So, what doctor Rx to patient?
Dr Pfotenhauer: It is important to actually write this information on the script. You write down the patient's base dose, whatever that may be. Then you can either write up the correction scale, or you can write, "increase 2 U for every 50 mg/dL [in serum glucose concentration] above 150 mg/dL up to 18 U [of insulin]," for example. It is really important to include the maximum quantity of units that you want the patient to take with every meal and then use that as your calculation dose for the day. For example, if your maximum dose is 20 U per meal, three times a day, you want to give the patient enough insulin so that the patient has 60 U per day for the month.OK, now if patient take 20 units a day, then it is 6 units to spring the needle, right? 30 * 6=180 units a month, right? Did doctor remember this units?
So, the first it is 6 units of insulin per meal. (150:50=3; 3*2=6 units.)
Now, What is the level of sugar when patient needs 20 units of insulin every meal? As I do remember so far, diabetes is pancreas disorder, insufficient insulin secretion. How this secretion related with amount of daily meals?
And also, when it is max amount of units for each 50 mg/dl, then how high level of sugar is it?
18:2 =9 for 50 * 9 = 450 mg/dl, if I am correct, right? So, the question is, what is the level of sugar would be if patient take 2 units for 50 mg/dl? 500 mg/dl. And for this level of sugar patient have to take how many units of insulin? It is 18 units for 450 mg/dl, and how many units for 150 mg/dl? To records if doctors do not know it in hospitals there is no one unit of insulin if patient has less the 200 mg/dl.
Still, it is not clear, how doctor Rx dose of insulin? Really, what if 150 mg/dl ia resulted by 300 units of insulin daily dose? So, for every 50 mg/dl I have to add 2 units? Then 300 units of insulin come from where? Math is good, but it does not do the job for insulin prescription. Sorry, doctors. You are too low in diabetes understanding. Better do not show up on public with your so naive like Old Wive medical education. Shame of you!!!!!!!!!!!!!
Covering All the Bases When Prescribing Insulin: A Detailed 'How To'
via Ravenvoron
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