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
Steps:
(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
|
where:
• 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.
