Initial Insulin Order for Omnipod 5 with Humalog for 65-Year-Old Woman with A1C 11.0
For a 65-year-old woman weighing 230 pounds (104.5 kg) with an A1C of 11.0, the initial Omnipod 5 order with Humalog should start with a total daily dose of 0.5 units/kg/day, which equals approximately 52 units, with 50% as basal insulin (26 units) and 50% distributed as bolus insulin for meals.
Initial Insulin Dosing
- Start with a total daily dose of 0.5 units/kg/day (104.5 kg × 0.5 = 52 units) 1
- Program the Omnipod 5 with approximately 50% as basal insulin (26 units/day) 1
- Set the remaining 50% as bolus insulin distributed across meals 1
- Consider prescribing glucagon for emergency hypoglycemia management 1
Omnipod 5 System Setup
- Program fasting plasma glucose target of 90-130 mg/dL 1
- Set insulin sensitivity factor (correction factor) based on 1800/total daily dose = 1800/52 = approximately 35 mg/dL per unit 1
- Set insulin-to-carbohydrate ratio starting at 500/total daily dose = 500/52 = approximately 1:10 (1 unit per 10g carbs) 1
- Enable automated insulin delivery features of Omnipod 5 with Humalog 1
Monitoring and Titration Plan
- Instruct patient to check blood glucose at least 4 times daily initially 1
- Increase basal insulin by 2 units every 3 days until fasting glucose target is reached without hypoglycemia 1
- Adjust mealtime insulin by 1-2 units or 10-15% twice weekly based on postprandial readings 1
- For hypoglycemia episodes, determine cause and reduce corresponding dose by 10-20% 1
Special Considerations for Older Adults
- Monitor closely for hypoglycemia, especially nocturnal hypoglycemia 1
- Consider a slightly higher target range (90-150 mg/dL fasting, 100-180 mg/dL bedtime) given patient's age 1
- Evaluate for overbasalization if basal dose exceeds 0.5 units/kg/day 1
- Assess cognitive function and ability to manage the insulin pump technology 1
Advantages of Humalog with Omnipod 5
- Humalog (insulin lispro) has faster onset and shorter duration than regular insulin, making it ideal for pump therapy 2, 3
- Studies show improved postprandial glucose control with insulin lispro in pump users 3, 4
- Lower HbA1c values have been demonstrated with insulin lispro in pump therapy compared to regular insulin 4, 5
- Bolus doses can be administered immediately before meals rather than 30 minutes prior 2, 4
Follow-up Plan
- Schedule follow-up within 1-2 weeks to assess initial response 1
- Evaluate adequacy of insulin dose at every visit 1
- Consider adding GLP-1 RA if glycemic targets are not achieved with insulin optimization 1
- Reassess A1C in 3 months to determine effectiveness of therapy 1
Common Pitfalls to Avoid
- Underestimating initial insulin requirements with very high A1C (>10%) 1
- Failing to adequately educate on technology use and hypoglycemia management 1
- Not adjusting basal rates for varying insulin sensitivity throughout the day 1
- Overbasalization (using excessive basal insulin) leading to increased hypoglycemia risk 1