Module 5 Pharmacologic Management of Hospital Hyperglycemia: Insulin Management Part 2

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Module 5Pharmacologic Management of Hospital
HyperglycemiaInsulin Management Part 2
Attachment 2d
Diabetes Special Interest Group Georgia Hospital
Association
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Learning Modules
In this module you will practice applying
principles of insulin therapy in the hospital
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• Calculate basal-bolus insulin dose in a 52 year
  old man with type 2 diabetes, glucose values in
  the 200s, with weight of 90 kg who is eating
• First estimate total daily insulin requirements
• Total daily insulin 0.5 unit x 90 kg 45
  units
• Second, estimate basal insulin amount
• Basal insulin amount 0.5 x 45 23 units
• Third, estimate prandial (or bolus) insulin
• Prandial insulin (0.5 x 45)/3 7 units per
  meal
• Fourth, create a scale using a CF 30 (next
  slide)

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Calculate His Corrective Insulin Program
(170-110)/30 2
(225-110)/30 4
(275-110)/30 5
(325-110)/30 7
(375-110)/30 9
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• A 65 year old 82 kg woman with metastatic breast
  cancer is admitted for mental status changes. She
  has a 10 year history of diabetes on glipizide.
  Her A1c is 8.3. She is not eating and you hold
  her glipizide. You monitor q 6h bedside glucose.
  You start her on a mild sliding scale but after
  24 h her values range from 200 to 275 mg/dL. What
  would you do?
• A. Increase her sliding scale to aggressive
• B. Start scheduled basal insulin with corrective
  insulin
• C. Start a basal-prandial insulin program with
  corrective insulin
• D. Restart glipizide

Answer B
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• Calculate your patients initial insulin doses
• Estimate total daily insulin requirement
• Total daily insulin 0.5 unit x 82 kg 41
  units
• Estimate basal insulin amount
• Basal insulin amount 0.5 x 41 20 units
• Construct a corrective insulin program using a CF
  20
• You will want a lower CF she is probably pretty
  insulin resistant

(170-110)/20 3
(225-110)/20 6
(275-110)/20 8
(325-110)/20 11
(375-110)/20 13
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• A 90 kg 70 year old man with advanced COPD is
  admitted with pneumonia and bronchospasm. He has
  no history of diabetes but his admission glucose
  is 281 mg/dL. You will have to start steroids.
  You check the A1c and it is 7.3. He is eating.
  During the first 24 h his bedside glucose values
  are in the high 200s. You decide to put him on a
  scheduled insulin program. Calculate the doses.
• First estimate total daily insulin requirements
• Total daily insulin 0.5 unit x 90 kg 45
  units
• Second, estimate basal insulin amount
• Basal insulin amount 0.5 x 45 22 Units
• Third, estimate meal time insulin
• Prandial insulin (0.5 x 45)/3 7 Units per
  meal
• Fourth, continue corrective insulin program

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• You have started your 70 year old man on the
  scheduled insulin program, but after 24 h his
  glucose values are still in the 250 to 300 range.
  He is on Prednisone. Pseudomonas grew out of his
  sputum and blood. You have become reconciled to
  the fact that he will be with you a few more
  days. How much should you increase his insulin?
  Calculate the new doses.

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• After another 24 h your 70 year old mans blood
  glucose values are improving, but are still in
  the 200 to 249 range. How much would you increase
  his insulin? Calculate the new doses.

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• After another 24 h your 70 year old mans blood
  glucose values are now in the 160 to 190 mg/dL
  range. While they are now much improved, knowing
  the importance of good glucose in the hospital,
  and being the OCD person you are, you are still
  not happy and want to get him to a 120 to 150
  mg/dL target. How much would you increase his
  insulin now? Calculate the new doses.

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Congratulations, he is now at target.