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Table 1—

Insulin treatment protocols

  • A. Basal-bolus regimen with insulin glargine and glulisine

    • Discontinue oral antidiabetic drugs on admission.

    • Start total daily insulin dose:

      • 0.4 units · kg body wt−1 · day−1 when the admission blood glucose concentration is 140-200 mg/dl

      • 0.5 units · kg body wt−1 · day−1 when the admission blood glucose concentration is between 201-400 mg/dl

    • Give one-half of total daily dose as insulin glargine and one-half as insulin glulisine.

    • Give insulin glargine once daily at the same time of the day.

    • Give insulin glulisine in three equally divided doses before each meal. Hold insulin glulisine if patient is not able to eat.

 
Supplemental insulin 
    Give supplemental insulin glulisine following the “sliding-scale” protocol for blood glucose >140 mg/dl. 

  • If a patient is able and expected to eat all or most of his/her meals, give supplemental glulisine insulin before each meal and at bedtime following the “usual” column.

  • If a patient is not able to eat, give supplemental glulisine insulin every 6 h (6–12–6–12), following the “insulin-sensitive” column.

 
Insulin adjustment

  • If the fasting or mean blood glucose during the day is >140 mg/dl in the absence of hypoglycemia, increase insulin glargine dose by 20% every day.

  • If patient develops hypoglycemia (<70 mg/dl), decrease glargine daily dose by 20%.

 
Blood glucose monitoring 
    Measure blood glucose before each meal and at bedtime (or every 6 h if n.p.o.). 

  • B. Sliding scale regimen with regular insulin

    • Discontinue oral antidiabetic drugs on admission.

    • If patient is able and expected to eat all or most of his/her meals, give regular insulin before each meal and at bedtime, following the “usual” column.

    • If patient is not able to eat, give regular insulin every 6 h (6–12–6–12), following the “insulin sensitive” column.

 
Insulin adjustment

  • If fasting and premeal plasma glucose are persistently >140 mg/dl in the absence of hypoglycemia, increase insulin scale from the “insulin sensitive” to the “usual” column or from the “usual” to the “insulin-resistant” column.

  • If a patient develops hypoglycemia (blood glucose <70 mg/dl), decrease regular insulin from “insulin-resistant” to “usual” column or from the “usual” to “insulin-sensitive” column.

 
Blood glucose monitoring 
    Measure blood glucose before each meal and at bedtime (or every 6 h if n.p.o.). 

  • C. Supplemental insulin scale

 

  • A. Basal-bolus regimen with insulin glargine and glulisine

    • Discontinue oral antidiabetic drugs on admission.

    • Start total daily insulin dose:

      • 0.4 units · kg body wt−1 · day−1 when the admission blood glucose concentration is 140-200 mg/dl

      • 0.5 units · kg body wt−1 · day−1 when the admission blood glucose concentration is between 201-400 mg/dl

    • Give one-half of total daily dose as insulin glargine and one-half as insulin glulisine.

    • Give insulin glargine once daily at the same time of the day.

    • Give insulin glulisine in three equally divided doses before each meal. Hold insulin glulisine if patient is not able to eat.

 
Supplemental insulin 
    Give supplemental insulin glulisine following the “sliding-scale” protocol for blood glucose >140 mg/dl. 

  • If a patient is able and expected to eat all or most of his/her meals, give supplemental glulisine insulin before each meal and at bedtime following the “usual” column.

  • If a patient is not able to eat, give supplemental glulisine insulin every 6 h (6–12–6–12), following the “insulin-sensitive” column.

 
Insulin adjustment

  • If the fasting or mean blood glucose during the day is >140 mg/dl in the absence of hypoglycemia, increase insulin glargine dose by 20% every day.

  • If patient develops hypoglycemia (<70 mg/dl), decrease glargine daily dose by 20%.

 
Blood glucose monitoring 
    Measure blood glucose before each meal and at bedtime (or every 6 h if n.p.o.). 

  • B. Sliding scale regimen with regular insulin

    • Discontinue oral antidiabetic drugs on admission.

    • If patient is able and expected to eat all or most of his/her meals, give regular insulin before each meal and at bedtime, following the “usual” column.

    • If patient is not able to eat, give regular insulin every 6 h (6–12–6–12), following the “insulin sensitive” column.

 
Insulin adjustment

  • If fasting and premeal plasma glucose are persistently >140 mg/dl in the absence of hypoglycemia, increase insulin scale from the “insulin sensitive” to the “usual” column or from the “usual” to the “insulin-resistant” column.

  • If a patient develops hypoglycemia (blood glucose <70 mg/dl), decrease regular insulin from “insulin-resistant” to “usual” column or from the “usual” to “insulin-sensitive” column.

 
Blood glucose monitoring 
    Measure blood glucose before each meal and at bedtime (or every 6 h if n.p.o.). 

  • C. Supplemental insulin scale

 
□ Insulin sensitive□ Usual□ Insulin resistant
Blood glucose (mg/dl)    
    >141–180 2 4 6 
    181–220 4 6 8 
    221–260 6 8 10 
    261–300 8 10 12 
    301–350 10 12 14 
    351–400 12 14 16 
    >400 14 16 18 
□ Insulin sensitive□ Usual□ Insulin resistant
Blood glucose (mg/dl)    
    >141–180 2 4 6 
    181–220 4 6 8 
    221–260 6 8 10 
    261–300 8 10 12 
    301–350 10 12 14 
    351–400 12 14 16 
    >400 14 16 18 

Check appropriate column and cross out other columns. The numbers in each column indicate the number of units of glulisine or regular insulin per dose. Supplemental dose is to be added to the scheduled dose of glulisine or regular insulin.

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