9
Recommendations 9.1 and 9.2 (cont'd)
Remarks:
▶ Patients who perform CC in the outpatient setting, including those with insulin-treated
T2D, may prefer to continue this method of calculating prandial insulin doses during
hospitalization. An insulin to carbohydrate ratio (ICR) is used to calculate the prandial
dose of insulin when using CC.
▶ A policy to guide CC for calculating prandial insulin dosing in the hospital is necessary
for safe implementation, as is expertise from a health care professional knowledgeable in
diabetes management.
▶ In hospitals where expertise, resources, and training are available, either CC or fixed
prandial insulin dosing can be implemented.
▶ Adjustments to the ICR may be needed in the hospital setting to address the impact
of illness or treatments on insulin requirements (e.g., glucose-interfering medications,
infection, surgery, insulin resistance).
Recommendation 10.1
➤ In adults with no prior history of diabetes hospitalized for non-critical
illness with hyperglycemia (defined as BG >140 mg/dL [7.8 mmol/L])
during hospitalization, we suggest initial therapy with correctional
insulin over scheduled insulin therapy (defined as usual basal or basal/
bolus) to maintain glucose targets in the range of 100–180 mg/dL
(5.6–10.0 mmol/L). For patients with persistent hyperglycemia (≥2
POC-BG measurements ≥180 mg/dL [≥10.0 mmol/L] in a 24-hour
period on correctional insulin), we suggest the addition of scheduled
insulin therapy. (2|⊕
)
Recommendation 10.2
➤ In adults with diabetes treated with diet or non-insulin diabetes
medications prior to admission, we suggest initial therapy with
correctional insulin or scheduled insulin therapy to maintain glucose
targets in the range of 100–180 mg/dL (5.6–10.0 mmol/L). For
hospitalized adults started on correctional insulin alone and with
persistent hyperglycemia (≥2 POC-BG measurements ≥180 mg/dL in a
24-hour period [≥10.0 mmol/L]), we suggest addition of scheduled insulin
therapy. We suggest initiation of scheduled insulin therapy for patients
with confirmed admission BG >180 mg/dL (≥10.0 mmol/L). (2|⊕
)
Recommendation 10.3
➤ In adults with insulin-treated diabetes prior to admission who are
hospitalized for non-critical illness, we recommend continuation of the
scheduled insulin regimen modified for nutritional status and severity
of illness to maintain glucose targets in the range of 100–180 mg/dL
(5.6–10.0 mmol/L). (1|⊕⊕
)
Remarks:
▶ Reductions in the dose of basal insulin (by 10–20%) at time of hospitalization may be
required for patients on basal heavy insulin regimens (defined as doses of basal insulin
≥0.6–1.0 units/kg/day), in which basal insulin is being used inappropriately to cover
meal-related excursions in blood glucose.
