Treatment
Table 1. Regimen for Noncritically Ill Patients with
Type 2 Diabetes
A. Basal insulin orders
Discontinue oral diabetes drugs and noninsulin injectable diabetes medications upon
hospital admission.
Starting insulin: calculate the total daily dose as follows:
• 0.2-0.3 units/kg of body weight in patients aged ≥ 70 y and/or glomerular filtration
rate < 60 mL/min or lean insulin sensitive patients such as those with type 1
diabetes.
• 0.4 units/kg of body weight per day for patients not meeting the criteria above who
have BG concentrations of 7.8-11.1 mmol/L (140-200 mg/dL).
• 0.5 units/kg of body weight per day for patients not meeting the criteria above when
BG concentration is 11.2-22.2 mmol/L (201-400 mg/dL).
Distribute total calculated dose as approximately 50% basal insulin and 50% nutritional insulin.
Give basal insulin once (glargine/detemir) or twice (detemir/NPH) daily, at the same time
each day.
Give rapid-acting (prandial) insulin in three equally divided doses before each meal. Hold
prandial insulin if patient is not able to eat. Equalize carbohydrate content of each meal.
Adjust insulin dose(s) according to the results of bedside BG measurements.
• If fasting and premeal plasma glucose are persistently above 7.8 mmol/L (140 mg/dL)
in the absence of hypoglycemia, increase basal insulin.
• If a patient develops hypoglycemia (BG < 3.8 mmol/L [70 mg/dL]), decrease
basal insulin.
B. Supplemental (correction) rapid-acting insulin analog or regular insulin
Supplemental insulin orders.
• If a patient is able and expected to eat all or most of his/her meals, give regular or rapid-
acting insulin before each meal and at bedtime following the Usual column (below).
• If a patient is not able to eat, give regular insulin every 6 h (6-12-6-12) or rapid-acting
insulin every 4-6 h following the Insulin-sensitive column (below).
Supplemental Insulin Scale
BG (mg/dL) Insulin-sensitive Usual Insulin-resistant
> 141-180 2 4 6
181-220 4 6 8
221-260 6 8 10
261-300 8 10 12
301-350 10 12 14
351-400 12 14 16
> 400 14 16 18
NOTE: e numbers in each column indicate the number of units of regular or rapid-acting insulin analogs
per dose. "Supplemental" dose is to be added to the scheduled insulin dose. Give half of supplemental
insulin dose at bedtime. If a patient is able and expected to eat all or most of his/her meals, supplemental
insulin will be administered before each meal following the Usual column dose. Start at Insulin-sensitive
column in patients who are not eating, elderly patients, and those with impaired renal function. Start at
Insulin-resistant column in patients receiving corticosteroids and those treated with more than 80 units/day
before admission. To convert mg/dL to mmol/L, divide by 18.
