Patient selection: patient admitted to the hospital with Type 2 diabetes
Parameters:
(1) insulin glargine (long-acting insulin) dose
(2) insulin glulisine (rapid-acting insulin) dose
(3) fasting blood glucose in mg/dL
(4) episodes of hypoglycemia (with blood glucose < 70 mg/dL)
(5) response to insulin (usual, sensitive or resistant)
(6) blood glucose in mg/dL before each meal and at bedtime
Rules for adjusting long-acting insulin dose:
(1) If the fasting blood glucose is > 140 mg/dL AND no episodes of hypoglycemia occurred, then new dose should be (1.2 * (previous dose)).
(2) If an episode of hypoglycemia occurred then the new dose should be (0.8 * (previous dose)
Rules for supplemental rapid-acting insulin dose (see Table below):
(1) If the patient is able to eat normally, then give a supplemental dose based on the blood glucose before each meal and at bedtime.
(2) If the person is unable to eat, then give give a supplemental dose assuminig insulin sensitivity every 6 hours (6 AM, 12 noon, 6 PM and 6 midnight).
|
Premeal or Bedtime Blood Glucose
|
Usual Supplemental Dose of Rapid-Acting Insulin
|
|
<= 140
|
0
|
|
141 to 180
|
4
|
|
181 to 220
|
6
|
|
221 to 260
|
8
|
|
261 to 300
|
10
|
|
301 to 350
|
12
|
|
351 to 400
|
14
|
|
> 400
|
16
|
supplemental dose of rapid-acting insulin if insulin sensitive =
= (usual dose) - 2
supplemental dose of rapid-acting insulin if insulin resistant =
= (usual dose) + 2
