Evidence-Based Preprandial Glulisine Dosing

Introduction to Preprandial Insulin Dosing

• The American Diabetes Association recommends calculating preprandial doses using: (Total carbohydrates ÷ CIR) + (Current glucose - Target glucose) ÷ ISF 1
• Preprandial insulin must account for two components: carbohydrate coverage AND correction of elevated glucose 1, 2

Calculating Insulin Sensitivity Factor (ISF) and Carbohydrate-to-Insulin Ratio (CIR)

• ISF = 1500 ÷ Total Daily Dose (TDD) for regular insulin 1
• ISF = 1700 ÷ TDD for rapid-acting analogs like glulisine 1
• CIR = 500 ÷ Total Daily Dose (TDD) for regular insulin 1
• CIR = 450 ÷ TDD for rapid-acting analogs like glulisine 1

Administering Preprandial Glulisine

• Rapid-acting insulin analogs like glulisine should be injected 0-15 minutes before meals for optimal postprandial glucose control 3, 2
• The American Diabetes Association recommends a preprandial glucose target of 90-150 mg/dL (5.0-8.3 mmol/L), not a fixed 100 mg/dL 1

Titration and Monitoring

• If 2-hour postprandial glucose consistently >180 mg/dL, increase meal dose by 1-2 units or 10-15% 1, 2
• If hypoglycemia occurs, reduce corresponding dose by 10-20% 1, 2
• Reassess and adjust ISF/CIR every 3 days during active titration 1

Avoiding Common Pitfalls

• Do not give correction doses within 3-5 hours of the previous rapid-acting insulin dose, as insulin from the previous dose may still be active 1
• ISF and CIR should be recalculated every few weeks to months, not daily, as total daily insulin requirements change 1