Hyperglycemia

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). Supplemental Insulin Scale BG (mg/dL) > 141-180 181-220 221-260 261-300 301-350 351-400 > 400 Insulin-sensitive 2 4 6 8 10 12 14 Usual 4 6 8 10 12 14 16 Insulin-resistant 6 8 10 12 14 16 18 NOTE: The 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. • 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).

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