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).
