Dosing Insulin: The Most Important Thing Is the Educationl by Jay H. Shubrook, DO; Gerard Victor A. Sebastian, MD http://ift.tt/2f0QD1p
There are more and more MD who present how to use insulin, how to dose it. What is important, there is no one protocol that be used by MD and patients. "Let us see, what MD present as education for patient how to dose insulin:
Calculating Insulin Sensitivity: The 1500 Rule
Divide 1500 by the total daily dose of regular insulin, in units. For example, an individual with a total daily dose of 30 units of regular insulin has an insulin sensitivity factor of 50 (1500 ÷ 30). By this calculation, one unit of regular insulin would be estimated to lower this person's blood glucose by 50 mg/dL.
It is very interesting and very important. I try to find out, how insulin dose counted, how to find out how many units I have to inject into my belly. And what? The 1500 Rule, what is it? Why it is 1500 in first place? Why it is not 1800, or 2000? Where 1500 come from? No one comment. It is just The Rile!
Total dose of insulin, how this dose was found out? Why it is 30 units a day? So, when I try to figure out how many units a day I have to inject in my belly, then what are recommendations by MD? Mysterious The 1500 Rule. For mystical reason, it is 1500, and then there is another mystery, 30 units dose of insulin a day. After that they present that it is my sensitivity to insulin, and this dose of insulin would lower my blood sugar level by 50 mg/dl.
I wish to say, it is my math, and it is dose of insulin I have to inject in my own belly. Then say me, why there are so many mysterious numbers, no one even try to say, where they come from? Whose Art in Medicine is that? The article is, Dosing Insulin. So, MD must say, how diabetic must find out what dose of insulin inject daily. In stead, MD discuss time when we have to inject insulin. Do they able to listen what they are discussing? Not at all. They have no one idea how to dose insulin. Simple. Read this article, listen this video, and try to find out, what dose of insulin You, not some one else with sensitivity on insulin (1500 : 30 ) = 50. That 1 unit of insulin would decrease level of sugar in blood from 150 mg/ dl to 100 mg/dl. Perfect blood sugar level. Really?
Well, Dr. Banting, C. Best, took 10 units of insulin each, and went to hospital ward to inject insulin to comatose children. Both of them did not have low blood sugar. No one of them was diabetic.10 units of insulin, according to The 1500 Rule would be 500 mg/dl, right? I am not good in math, but I am good in logic. No one difference to diabetic, if one takes 1 unit of insulin. So, MD educate whom? Or MD need to pass education class before educate diabetics how to use insulin.
Why they publish this scam? At first, it is money, of cause. They got paid for this scam. Second, it is Prestige. They are happy to participate in education. It is the same as some witnesses participate in crime witness. "I am witness!!!! Can someone say me, please, what happened here?"
Jay H. Shubrook, DO: Hi. I'm Jay Shubrook, DO, professor and diabetologist at Touro University. We're at the 77th Annual American Diabetes Association Scientific Sessions. I'm here with one of my colleagues to continue the program on practical use of insulin in primary care.
Did I tell, do not donate to ADA? I did many times.
"Dr Sebastian: Today I'd like to talk about the timing of insulin dosing." - Really, what are you talking about? Timing of dose of insulin is absolutely have no meaning. The time of insulin injection probably do, but dosing of insulin, really, it is just the process to find out how many units of insulin one must inject in own belly. Two MD lost in discussion already.
Dr Sebastian: Every time I see new patients or new consults especially, I always explain to them the mechanism of action for each insulin and the best time to take these insulins. With the basal insulins, we all know that this insulin lasts for 24 hours. This is particularly true with Lantus® [insulin glargine injection] and the newest and longest-acting basal insulin product, Tresiba® [insulin degludec injection]. I always ask patients what time of day is convenient for them to take this medication, because it's better for patients to take them at least once a day and at the most convenient time so that they won't forget. Consistency is important for patients with this medication.
Scam!!!!!!!!!!!!Insulin does not last 24 hours. How do they found it that insulin last 24 hours? Did MD check up the level of insulin in diabetic blood? Not at all. So, if diabetic need 300 units of insulin daily, and MD counted it is 1 unit, then how long this unit will last in diabetic's blood? Just pay attention, what they are, two MD, talking about, and try to be alert. They switch from subject of discussion to the Brain Washing. How to find out that insulin injected in the morning still in blood in the eve? Really, this discussion is about what?
Dr Sebastian: Typically, I consider it if a patient's taking large doses of insulin—more than 60 or 80 units. If they're using insulin pens, some of these pens contain a maximum of 60 units. The newest pens now on the market can be up to 80 units. For patients taking 80-plus units of basal insulin, I usually recommend splitting the dose.
True? Scam!!!!!!!!!! In pen it is 300 units of insulin. In modern insulin pens it is limit of 80 units in one shot. So because of I need to take 300 units daily I take 80+80 units in the morning, and the rest of the pen in the eve. I take one shot to inject 160 units. I simple re-digit the pen, both times, in the morning and in the eve. So, what really educators do know about insulin? They even have no one idea that dose of insulin in one pen is 300 units. In modern pens it can be 450 units.
Dr Sebastian: What about mealtime insulin? We have many choices, and while we do give instructions to our patients, they may follow their own path when they take insulin. How do you introduce the concept of timing of the dose for mealtime insulin?
Really, if diabetic take own path then why they pretend this diabetic need their instructions?
Dr Sebastian: I discuss this with patients at length at every visit so that they get this proper time correctly. If they need more time, we have handouts that we give them. I also have diabetes educators in our clinic to give more information to our patients.
It is not diabetic who needs time to this discussions and understanding. It is MD who need money, and timing is very important part of payment. This is why they do have Educators, and it is even better now. They pass this jab to scribe. Low educated high school grad educate diabetics with college degree how to count dose of insulin no one MD capable to count. So interesting turn on! There is no one point, how to count dose of insulin to inject, and still, they pretend they educate diabetic how to time dose of injection and how many times put needle into belly.
OK, Scam is SCAM, and there is noting to discuss. I do share what I do and how do I count how many times to inject insulin, and how to do all this therapy. It is really simple to be by myself, because of no one of them have any idea what they are talking about.
At first, when I do have low blood sugar I do inject insulin before my first bite. I take Lantus Solo Star, long acting insulin which presented 24 hours. What does it men? Have no clue. But dose of insulin I inject when sugar is low start to work right away. It is not easy way to do. Sugar is already low, and it is obvious that with insulin shot it will go down. Right. But it does not go down very fast. In contrary, it is slow process of blood sugar lowering. At the same time if I do not take shot I am hungry, and it takes time to be satisfied with meal. If shot taken, then there is no any need in eating fast or too much. It is getting normal meal, as it is without low blood sugar.
Amount of carbs and calories has no one meaning. I dosing insulin according to the level of sugar in my blood, regardless of the any math which presented as any The Rules. I simple pay attention to my fasting level of sugar, and I do my 'two-hour-reading-test' sometimes to find out how even blood sugar run during the day.
Level of sugar in blood effected by many conditions: weather and sick days, space distractions and level of depression in that moment, constant inflammation and how it increase in that moment, and so so on. Now, it is presented that the meal, amount of meal, and work outs, activity, effect the level of insulin in blood, so it effect the dose of insulin e have to inject, and MD pretend to educate us, how to do so. In my experience, it is not the case that level of sugar effected by the meal we eat.
Try to do some test. Try to eat the meal at the same time a few days. The same activity. The same dose of insulin. Is this really true that the level of sugar in your own blood would be the same? In my blood it never happened. The level of sugar all the time different. This is why we are diabetics, compare with non-diabetics. In non-diabetic system , regardless what person eat or what person is doing, the level of sugar is about the same, as temperature of the body. In diabetic's blood the level of sugar is different all the time. Out body system not capable regulate the secretion of insulin. For us it takes longer to get meal too be processed. We are diabetics type 2, people with chronicle condition of Endocrine System Disorder. With time sugar will drop, but every time the process is longer, and sugar does not drop to the normal level. This is why we live with our condition about ten years, suffering, but still alive.
In Joslin Clinic there was dose of insulin 4,000 units within 24 hours. Say me, how they counted it? They did not counted it. And I can say, in condition like that diabetic was not capable to eat. But it is not meal dropped his sugar level and let diabetic to live, but 4,000 units of insulin. Next day this patient was injected about 2,000 units of insulin within 24 hours. When I read it, I just took it for granted, there is no limit in insulin dosing. I have to inject it as many units as it takes to curb risin sugar in blood. Not long time ago I injected 434 units withing 24 hours, and next day it was the same dose. Then sugar went down, and so dose of insulin. I will inject 500 units, 600 units, as many as it will take. The problem is only one. If I am in hospital in ER then there is no one unit of insulin for me, and I will never leave the clinic. I do worry about it. I try very hard do not go out of home, to stay at home, no clinic, no ER, no hospitals. Just try to still alive.
via Ravenvoron
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