Safe and effective dosing of basal-bolus insulin in patients receiving high-dose steroids for hyper-cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy

Veronica Brady, Sonali Thosani, Shouhao Zhou, Roland Bassett, Naifa Lamki Busaidy, Victor Lavis

Research output: Contribution to journalArticle

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Abstract

Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m2, and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81% of glucose measurements in the first cycle and 60% of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77% prandial and 23-37% basal. Nine of the 23 patients had at least one glucose value <70mg/dL, which accounted for 1.3% of all recorded glucose values. None of the patients had severe hypoglycemia. Conclusions: Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25% basal and 75% prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.

Original languageEnglish (US)
Pages (from-to)874-879
Number of pages6
JournalDiabetes Technology and Therapeutics
Volume16
Issue number12
DOIs
StatePublished - Jan 1 2014

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Vincristine
Doxorubicin
Cyclophosphamide
Dexamethasone
Steroids
Insulin
Drug Therapy
Hyperglycemia
Glucose
Meals
Inpatients
Hypoglycemia
Hypoglycemic Agents
Leukemia
Body Mass Index
Demography
Therapeutics

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

Cite this

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title = "Safe and effective dosing of basal-bolus insulin in patients receiving high-dose steroids for hyper-cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy",
abstract = "Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m2, and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81{\%} of glucose measurements in the first cycle and 60{\%} of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77{\%} prandial and 23-37{\%} basal. Nine of the 23 patients had at least one glucose value <70mg/dL, which accounted for 1.3{\%} of all recorded glucose values. None of the patients had severe hypoglycemia. Conclusions: Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25{\%} basal and 75{\%} prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.",
author = "Veronica Brady and Sonali Thosani and Shouhao Zhou and Roland Bassett and Busaidy, {Naifa Lamki} and Victor Lavis",
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Safe and effective dosing of basal-bolus insulin in patients receiving high-dose steroids for hyper-cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy. / Brady, Veronica; Thosani, Sonali; Zhou, Shouhao; Bassett, Roland; Busaidy, Naifa Lamki; Lavis, Victor.

In: Diabetes Technology and Therapeutics, Vol. 16, No. 12, 01.01.2014, p. 874-879.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Safe and effective dosing of basal-bolus insulin in patients receiving high-dose steroids for hyper-cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy

AU - Brady, Veronica

AU - Thosani, Sonali

AU - Zhou, Shouhao

AU - Bassett, Roland

AU - Busaidy, Naifa Lamki

AU - Lavis, Victor

PY - 2014/1/1

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N2 - Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m2, and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81% of glucose measurements in the first cycle and 60% of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77% prandial and 23-37% basal. Nine of the 23 patients had at least one glucose value <70mg/dL, which accounted for 1.3% of all recorded glucose values. None of the patients had severe hypoglycemia. Conclusions: Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25% basal and 75% prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.

AB - Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6-40.9) kg/m2, and median age was 61 (range, 40-80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cycle of hyper-CVAD. Hyperglycemia accounted for 81% of glucose measurements in the first cycle and 60% of glucose values in the last cycle. Patients received 1-1.3 units/kg of insulin per cycle, and insulin requirements were similar across cycles. The distribution of basal versus bolus insulin for each cycle was 63-77% prandial and 23-37% basal. Nine of the 23 patients had at least one glucose value <70mg/dL, which accounted for 1.3% of all recorded glucose values. None of the patients had severe hypoglycemia. Conclusions: Multiple-dose insulin therapy initiated at 1-1.2 units/kg/day, distributed as 25% basal and 75% prandial, reduced hyperglycemia in patients who were receiving high-dose dexamethasone as part of hyper-CVAD.

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