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



(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


141 to 180


181 to 220


221 to 260


261 to 300


301 to 350


351 to 400


> 400



supplemental dose of rapid-acting insulin if insulin sensitive =

= (usual dose) - 2


supplemental dose of rapid-acting insulin if insulin resistant =

= (usual dose) + 2


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