From the Research
For a patient with pancreatic cancer experiencing hyperglycemia, a basal-bolus insulin regimen is the most appropriate approach to control blood glucose levels and minimize the risk of morbidity and mortality. This regimen typically includes a long-acting insulin such as insulin glargine (Lantus) or insulin detemir (Levemir) once daily for basal coverage, combined with rapid-acting insulin such as insulin aspart (NovoLog), insulin lispro (Humalog), or insulin glulisine (Apidra) before meals for bolus coverage 1. The starting dose is usually calculated based on body weight, with approximately 0.3-0.5 units/kg/day total insulin, divided as 50% basal and 50% bolus (split between meals) 1. Some key points to consider when implementing this regimen include:
- Blood glucose monitoring should be performed 4 times daily (before meals and at bedtime), with dose adjustments made every 2-3 days based on patterns 1.
- The flexibility of the basal-bolus approach allows for adjustments during periods of variable oral intake, which is common in pancreatic cancer patients who may experience nausea, early satiety, or other gastrointestinal symptoms 1.
- Oral agents may be less effective and potentially contraindicated due to the patient's advanced age and cancer status, making insulin therapy a preferred option 2, 1.
- A basal-bolus insulin strategy has been shown to result in better glycemic control than sliding scale insulin and lower risk of hypoglycemia than premixed insulin regimen 1. It's worth noting that the most recent and highest quality study 1 supports the use of a basal-bolus insulin regimen in hospitalized patients, including those with pancreatic cancer, to achieve optimal glycemic control and minimize the risk of complications.