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4 Treatment Table 1. Currently Available Injectable Insulin Preparations Prandial or correctional insulin preparations Very rapid-acting insulin Fast aspart Lispro aabc Rapid-acting insulins Aspart Glulisine Lispro a Short-acting insulin Regular insulin Basal insulin preparations Intermediate-acting insulin Neutral protamine Hagedorn (NPH) Long-acting insulins Glargine b Detemir Degludec a a Available in U100 and U200 preparations. b Available in U100 and U300 preparations. Recommendation 1.1 ➤ In adults with insulin-treated diabetes hospitalized for non-critical illness who are at high risk of hypoglycemia, we suggest the use of real time continuous glucose monitoring (CGM) with confirmatory bedside POC-BG monitoring for adjustments in insulin dosing rather than POC- BG testing alone in hospital settings where resources and training are available. (2|⊕⊕ ) Remarks: ▶ In hospitals where CGM is not available, monitoring of BG levels can be continued with POC-BG testing as an alternative option. ▶ Patients identified as being at high risk for hypoglycemia include but are not limited to the following criteria: age ≥65 years; body mass index (BMI) ≤27 kg/m 2 ; total daily dose of insulin ≥0.6 units/kg ; history of Stage 3 or higher chronic kidney disease (eGFR < 60 mL/min/1.73m 2 ), liver failure, cerebrovascular accident, active malignancy, pancreatic disorders, congestive heart failure, or infection; or history of preadmission hypoglycemia or hypoglycemia occurring during a recent or current hospitalization; or impaired awareness of hypoglycemia. This recommendation does not apply to situations in which CGM may not be accurate, including in patients with extensive skin infections, hypoperfusion, or hypovolemia or those receiving vasoactive or pressor therapy. In addition, some medications can cause inaccurate CGM readings (e.g., acetaminophen >4 g/day, dopamine, vitamin C, hydroxyurea).

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