From North Carolina, USA:
What time should a 60 year old woman with Type 2 diabetes for 10 years, who works 6 P.M. - 6 A.M. in a mill in 2on/2off schedule, take her bedtime insulin dose? She is on a sulfonylurea during the "day". Will a 10 P.M. NPH insulin dose for someone who eats the main meal of the "day" at 11:30 P.M. accomplish what BIDS [Bedtime Insulin, daytime sulfonylurea] therapy will? Can you refer me to any references to document my recommendation to change to a different time? This person eats at 12 noon, 8:30 P.M. and 11:30 P.M. and occasionally a light snack of fruit or crackers at 7 A.M. before going to bed. On her days off, she goes to bed at midnight and has a more "normal" schedule for the day.
I have used the BIDS type therapy extensively both with many patients and for myself. The bedtime NPH is primarily working to "turn down" the liver glucose production and it makes no difference whether one is awake or sleeping to do that job, but if the patient is eating through the night you would think they would need more insulin but in some cases it is just the opposite. By eating in the night they stimulate their pancreas to give them some insulin and in fact need a little less. Of course another variable is how much effort they put in at work or is the exercise mostly jumping to conclusions (like my job). It is variable from person to person.
I would recommend that you consider starting with a conservative dose of N at 10 P.M. and then keep records until you have identified whether she needs more when sleeping or when working. The formula we use to determine this dose is: weight in pounds divided by 10. For example, a 160 lb woman starts with 16 (or 15 if easier to read on the syringe) and then we add 4-5 units a week until we get the fasting blood glucose below 140. We stop at 140 because the blood glucose will usually continue to improve over the next few weeks as their glucose toxicity improves. If this patient continues to have problems with high blood glucoses after meals, consider adding some Humalog to cover large meals. The Humalog before meals is a great treatment for shift workers because it is only covering blood glucose levels when they are eating.
Original posting 3 Apr 1999
Posted to Insulin
Last Updated: Tuesday April 06, 2010 15:09:02
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