![]() Knowing a diabetic patient’s home regimen can be helpful when establishing a total daily dose. ![]() Add up the insulin used in a patient’s home regimen. Related article: Insulin protocol review: the transition from IV to sub-QĢ. For patients with poor control, consider factoring in another 10% to your total daily dose. You should also take into account how well the patient’s glucose was controlled in the ICU on the preceding day. Once patients start eating, add the rest in bolus amounts. You should give 50% of that total dose as basal insulin about four hours before patients’ IV insulin is turned off, Dr. Between 40% and 50% of that total dose should be administered as basal, with the rest dosed out in nutritional boluses.įor patients who aren’t eating much, that calculation is likewise the total daily dose. Because patients’ insulin needs are tapering down a bit as they exit the ICU, he adds, you don’t need to supply the same daily dose.įor patients eating substantial amounts of food, you can use that calculated amount as the total daily dose. “It’s a little correction to prevent any hypoglycemia,” says Dr. Update: Standards of medical care in inpatient diabetes care That gives you a number that should equal 80% of the daily infusion dose. When Deepak Asudani, MD, a hospitalist at Baystate Medical Center in Springfield, Mass., transitions patients from IV insulin in the ICU to sub-Q insulin on the wards, he uses the following formula: Take the average hourly insulin infusion rate over the past six hours and multiply that rate by 20. Base total sub-Q dose on insulin infusion rates. Here’s a look at how two hospitalists use these strategies in their day-to-day practice.ġ. ![]() You still have to bring art to each approach, adjusting doses according to such factors as illness severity and eating status. “The pharmacology is never going to work if we don’t follow physiology.”Īny one of these approaches will produce a safe, conservative initial insulin dose, but experts warn that none of the strategies by itself is a slam dunk. For more stories that focus on glycemic control for diabetic inpatients, click here.īut as hospitalists switch from sliding scale to basal and bolus dosing, how do they calculate a safe total daily dose to start with? Experts say that physicians can use any of three different strategies, depending on whether patients have been using insulin as either an outpatient or in the ICU. Our November/December 2021 article focuses on the use of sliding scale insulin treatment: Sliding scale insulin for inpatients gets some respect. Seek informed advise, and know your limitations.Evidence keeps mounting that high blood sugars lead to worse outcomes in hospitalized patients “and that sliding scale regimens produce both more hyperglycemia and hypoglycemia. If this does not make sense to you, then you should be smart enough to know that you don't know enough to be dosing these medications safely. If you are doing another medication, use a syringe that is appropriately marker (and of correct size to ensure accuracy).įinally, TB syringes are for TB tests! They should only be used for placement of PPD blebs by a healthcare professional. If you are dosing insulin, use units and an insulin syringe. It is never appropriate to try and "convert" or "make do". Please be advised that if you do not have the correct syringe the answer to your problem is to get one - there are programs/pharmacies/hospitals that can help with this. ![]() This post is forcefully worded as the implications of mis-dosing insulin, or any other medication, can be VERY severe. Use mL syringes for medications that are clearly dosed in mL.ĭO NOT (as the previous post stated) assume that 100units is 1cc Use insulin syringes for insulin, which is dosed in units. This is not a mathematical challenge, and trying to convert in such a fashion is foolish. There is a reason that the syringes are different. A dosing measure of insulin is always in units and should NEVER be converted to mL! ![]()
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