A patient with Type 2 diabetes who is admitted to the hospital may be managed with a basal-bolus insulin regimen. Umpierrez described one such regimen consisting of an initial regimen with subsequent dosage adjustments. The authors are from Emory University and the University of Miami and participated in the RABBIT-2 Trial.


Patient selection: patient admitted to the hospital with Type 2 diabetes


Insulins used:

(1) long-acting insulin for once a day dosing: insulin glargine (Lantus)

(2) rapid-acting insulin analogue for multiple daily dosing: insulin glulisine



(1) Discontinue oral hypoglycemic drugs once admitted to the hospital.

(2) Determine the initial total daily insulin dose (see below).

(3) Measure blood glucose before each meal and at bedtime (every 6 hours if npo).

(4) Hold premeal rapid-acting insulin if no meal is eaten.


Determining the initial insulin dose based on body weight:

Admission Blood Glucose

Initial Daily Dose of Insulin

140 to 200 mg/dL (7.77 to 11.10 mmol/L)

0.4 units per kg body weight

201 to 400 mg/dL (11.11 to 22.2 mmol/L)

0.5 units per kg body weight



• The weight appears to be actual body weight.

• Blood glucose appears to be whole blood glucose.


dose of insulin glargine in units =

= 0.5 * (initial daily dose of insulin)


dose of insulin glulisine to give 3 times a day =

= 0.5 * (initial daily dose of insulin) / 3 =

= 0.167 * (initial daily dose of insulin)


The dose of insuline glargine is given once per day at the same time each day.


The dose of insulin glulisine is given before each meal.


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