Revised 07.15.

15
Feleke, Afomia
Figure 1. Basal, Bolus, Correction

Breakfast Lunch Dinner

r,0 r~
. --
30% hyperglycemia vs. < 5% hypoglycemia "v t ATf\

4 Associated with
Prolonged LOS
<' Increased mortality --v.
< Increased morbidity
4:00 12:(^ 16:00 i 20:00 24:00 4:00
# AACE/ADA Glycemic goals (Non-ICU) Time
Preprandlal < 140 mg/dL; Postprandial < 180 mg/dL
Correctional insulin monotherapy versus scheduled (basal, bolus correction) versus basal plus schedule (basal + correction)

Table 1. Insulin pharmacokinetics

_1K.
Didr<
<15 minutes 1 - 2 hours 3-4 hours
Nc
Mum.ilucji' (I
Rogulai 30 minutes - 1 hour 2 - 3 hours 3-6 hours

1.5 hours 4 -12 hours Up to 24 hours

I rvtmir - (dotomii) 1-2 hours Peakless Up to 24 hours

( "8 1 - 2 hours Peakiess Up to 24 hours
d insulin! 10 - 30 minutes 1.5 - 5 hours Up to 24 hours
nterm

Table 2. Insulin initiation and titration

Initiating scheduled insulin
(Basal, bolus, correction)
A)Patients with renal dysfunction (GFR < 60 ml/min or Scr >2 mg/dL) or elderly (> 70 YO)^ TDD = 0.3 units/kg
B) Patients without the above criteria in A, but with BG of 140-200 mg/dL TDD = 0.4 units/kg
C)Patients without the above criteria in A, but with BG of 201-400 mg/dL TDD = 0.5 units/kg
D)Insulin-resistant patients or friose receiving corticosteroids ^TDD = 0.7 units/kg
***50% of TDD = basal insulin; 50% of TDD = prandial insulin (administered with meals)***

Correction insulin based on insulin sensitivity of patient using theirTDD of insulin

Titrating insulin
Patients that are NPO
Transitioning from IV to SQ
Dose = [(Insulin infusion rate x 24 hours) x 0.8] OR (Average insulin infusion rate x 20) ^
o Low dose [0 - 40 units/day]; f^edium [40 - 80 units/day]; High [ >80 unite/day]
Basal insulin
o Fasting BG > 140 mg/dL
^10% if patient is on < 0.5 units/kg/day [TDD] or BG 140 - 180 mg/dL
4^20% if patient is on > 0.5 units/kg/day [TDD] or BG > 180 mg/dL
o Fasting BG 70 - 99 mg/dL
vHO % for all patients
o BG < 70 mg/dL
4^20% for all patients
Mealtime/bolus insulin (if patient eating')
o Preprandial > 140 mg/dL OR Random > 180 mg/dL
4^10% if patient is on < 0.5 units/kg/day [TDD] or BG 140 - 180 mg/dL
'^20% if patient is on > 0.5 units/kg/day [TDD] or BG > 180 mg/dL
o Preprandial/random BG 70 99 mg/dL
4/10 % for all patients
o Preprandial/random BG < 70 mg/dL
4^20% for all patients
Assess if correction insulin should be adjusted as well V
Basal insulin should be continued at 50% of total daily dose of insulin (i.e. full basal dose) - ^ ^
0 (NPH should be divided either Q8H or Q12H)
Correction insulin with appropriate BG checks ^
Using the last 4-6 hours of data ensure:
BG is well controlled
^ Insulin infusion has been running for at least 12 hours and rate has stabilized (i.e. no more than 1
unit/hr variation)
50.':
If patient was NPO while receiving IV insulin^ 100% of the calculated dose is basal
If patient was eating while receiving IV insulin ^ 50% of the calculated dose is basal and 50% is prandial
Discontinue IV insulin ~ 2 hours AFTER the first dose of basal/long acting SQ insulin is administered or ~ 30
minutes after a short/rapid acting insulin is administered