The formula for calculating basal insulin (BI) dose using IVI data is well established. Patients eating on IVI is becoming increasingly common. Guidelines supporting the addition of 2-4U of SQ PI to IVI to curb postprandial hyperglycemia (PPH) are based on minimal evidence. We present a novel formula (NF) to calculate the PI requirement on IVI, supported by data from 30 patients.

We conducted a prospective observational study of 30 patients admitted to the ICU and floors of a tertiary care center, eating on IVI with hourly BG checks, and requiring transition to SQ insulin (SQI) between 1/23/19-1/6/21. PI dose = [difference in 1st hour (hr)] + (1/2 the difference for hrs 2-3) between the increased IVI and BI rates. For example, if BI rate is 2U/hr and drip rate increases to 4, 6, 4 U/hr in 1-3 hrs after intake, the PI dose is 2 + 4/2 + 2/2 = 5U. Glycemic outcomes analyzed: change in BG 0-3 hrs post-meal off IVI, median ± SD BG off IVI, and mean PI dose added to IVI. We compared 0-3 hr post-meal median BG and IVI rates before (control) and after (study group) the addition of PI to IVI.

Four, 21, and 5 patients have no DM, T2D, and T1D, respectively. Steroid was used in 28 patients. Renal transplant (37%), hematologic malignancies (23%), CABG/heart/lung transplant (13%), liver transplant (10%), and others were included. Median ± SD BG after transition to SQI was 177.5 ± 25.4 mg/dL. Defined as having a CV of BG off IVI <31%, 29 patients had a well-matched PI dose. Mean change in BG 0-3 hrs post-meal following the transition was 36.8 mg/dL. Adding PI to IVI resulted in a median ± SD change in BG and IVI rate of -46 ± -17.2 mg/dL and -5.5 ± -1.7 U/hr, respectively. Mean PI dose added to IVI was 12.4U (range 2-42U) for all patients and 10.5U (3-42U) for those with T2D. No hypoglycemia occurred.

We demonstrate that the NF is safe and effective in predicting the PI dose to result in 100% success in IVI to SQI transition in the most complex patients, and the mean PI dose is 3 folds higher than traditionally proposed. Adding PI to IVI effectively curbs the PPH and IVI rates.

Disclosure

J. H. Chao: None. I. B. Hirsch: Consultant; Self; Abbott Diabetes, Bigfoot Biomedical, Inc., Research Support; Self; Insulet Corporation, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic.

© 2021 by the American Diabetes Association
2021
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