INSULIN

Insulin 0.9 Unit/kg/day

40% total dose given by basal insulin

60% divided by 3 to give before each meal (prandial)

Start by 65% total

Hyper>hypoglycemia

CASE 1

Seizure, low intake ketosis

Ketosisrelative or absolute deficiency in insulin

Severe stress release contraregulatory hormonegive higher level insulin to prevent

ketogenesisbasal dose of insulin by iv. Infusion

60 kg 54 U/day

40% x 54 = 21.6 U

Ketosis aim between 200-250 g/dl To prevent ketosis

Too low glucose starvation ketosis

ICU check GDS every 1-2 hr, increase insulin 0.5-1 U / hr

Increase 25%, decrease 50% to prevent hypoglycemia

Ward conservative basal dose and correct for every meal

Every Unit of insulin decrease 6-7 g/dl blood glucose

Never use long acting SC insulin risk of hypoglycemia

IV infusion can be stopped

OPDgive basal insulin (long acting)

Transition IV to SC risk factor controlled

1.5 U/hr basal dose 36U long acting insulin (detemir/levemir, glargine/lantus)
CASE 2

Unsure of DM diagnosis check GDS every meal

In patient goal 150-200 g/dl

Sliding scale cut off > 200

CASE 3

Prandial insulin must be followed by >50% food eaten

60 kg = 60% x 54 = 32 U/day for prandial, divided by 3 meals = 10-11 Unit/meal

Start from 60-80% give 6 Unit at first

Check blood glucose chart

Next day, morning GDS 250, afternoon 200, evening 300

Preprandial GDS is reflection of previous insulin effect

Morning dosage is adequate

Evening dosage increase by 4 unit become 10 Unit

Afternoon dosage increase by 10 Unit become 16 Unit

Food intake <50% or anorexia use rapid acting insulin after the meal

Give half dose if intake <50%

No intake = dont give insulin