Insulin dose adjustment

Posted on December 20, 2009

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http://www.diabetesguidelines.com/

 

Guidelines for Using Rapid-acting Insulin Analogs for Hospitalized Adult Patients with Diabetes Mellitus: Lispro (Humalog®) or Aspart (Novolog®) or Glulisine (Apidra®) Insulins

1. Background
Lispro and Aspart are rapid-acting analogs of human insulin and work more quickly than Regular insulin to lower blood glucose

• Very quick onset of action, usually 10 to 15 minutes, and lasts about 4 hours http://www.healthsystem.virginia.edu

• Should be used with a basal insulin, such as NPH, glargine, Ultralente, or Lente

• Only administer subcutaneously

• Can be given to correct pre-meal hyperglycemia and to provide insulin to cover the post-meal glucose rise

• Administer 5 to 15 minutes before a meal but can be given up to 20 minutes after the start of a meal for patients with uncertain appetite or erratic food consumption

• Should be given in the hospital only after the meal has been served, i.e. food is in front of patient ready to be consumed

• Some patients use carbohydrate counting to determine dose to cover post-meal glucose rise; for insulin-sensitive patients start with 1 unit per 15 grams carbohydrate and for less insulin-sensitive patients use 1 unit per 10 grams carbohydrate

2. Contraindications

• Patients who are NPO

• Patients with severe gastroparesis

• Do not substitute for Regular insulin

3. Indications

• Patients using this insulin for meals and/or sliding scale at home

• Per Endocrinology recommendation

4. Supplemental (sliding scale) Lispro or Aspart insulins to be administered in addition to scheduled insulin to correct pre-meal hyperglycemia

Low dose algorithm (for patients using <40 units insulin daily)

Add 1 unit if pre-meal BG 150-199mg/dl

Add 2 units if pre-meal BG 200 – 249

Add 3 units if pre-meal BG 250 – 299

Add 4 units if pre-meal BG 300 – 349

Add 5 units if pre-meal BG >349

Medium dose algorithm (for patients using 40 to 80 units insulin daily)

Add 1 unit if pre-meal BG 150-199mg/dl

Add 3units if pre-meal BG 200 – 249

Add 5 units if pre-meal BG 250 – 299

Add 7 units if pre-meal BG 300 – 349

Add 8 units if pre-meal BG >349

High dose algorithm (for patients using >80 units insulin daily)

Add 2 unit if pre-meal BG 150-199mg/dl

Add 4 units if pre-meal BG 200 – 249

Add 7 units if pre-meal BG 250 – 299

Add 10 units if pre-meal BG 300 – 349

Add 12 units if pre-meal BG >349

 
 
 
 
 
Posted in: insuline, tratament