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    Diabetes Cheat Sheet

    Uploaded by

    manuel iglesias
    This document provides tips for inpatient diabetes management, including: 1) Types of insulin, their onset, peak and duration times. 2) Insulin patterns for patients eating meals, including calculating basal and mealtime doses. 3) Strategies for patients taking prednisone or who are NPO, including adjusting insulin doses. 4) Guidelines for supplemental insulin scales and calculating carb ratios. 5) Managing insulin for enteral or parenteral nutrition, including interrupting nutrition.

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    © All Rights Reserved
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    Diabetes Cheat Sheet

    Uploaded by

    manuel iglesias
    211 views2 pages
    This document provides tips for inpatient diabetes management, including: 1) Types of insulin, their onset, peak and duration times. 2) Insulin patterns for patients eating meals, including calculating basal and mealtime doses. 3) Strategies for patients taking prednisone or who are NPO, including adjusting insulin doses. 4) Guidelines for supplemental insulin scales and calculating carb ratios. 5) Managing insulin for enteral or parenteral nutrition, including interrupting nutrition.

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    insulin modes

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    This document provides tips for inpatient diabetes management, including: 1) Types of insulin, their onset, peak and duration times. 2) Insulin patterns for patients eating meals, including calculating basal and mealtime doses. 3) Strategies for patients taking prednisone or who are NPO, including adjusting insulin doses. 4) Guidelines for supplemental insulin scales and calculating carb ratios. 5) Managing insulin for enteral or parenteral nutrition, including interrupting nutrition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    211 views2 pages

    Diabetes Cheat Sheet

    Uploaded by

    manuel iglesias
    This document provides tips for inpatient diabetes management, including: 1) Types of insulin, their onset, peak and duration times. 2) Insulin patterns for patients eating meals, including calculating basal and mealtime doses. 3) Strategies for patients taking prednisone or who are NPO, including adjusting insulin doses. 4) Guidelines for supplemental insulin scales and calculating carb ratios. 5) Managing insulin for enteral or parenteral nutrition, including interrupting nutrition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Tips for Inpatient Diabetes Management

    Types of insulins
    Onset Peak Duration
    Lispro, Aspart or
    5-15 min 1-2 hours 3-4 hours
    Glulisine (Apidra)
    Regular 30-60 min 2-4 hours 4-6 hours
    NPH/Lente 1-2 hours 4-8 hours 14-18 hours
    Ultralente 2-4 hours Unpredictable 16-20 hours
    Glargine 1-2 hours Flat 24 hours

    Insulin patterns for patients eating meals


    Strategy 1:
    1. Determine 24 hr basal requirement: by multiplying 8 hr overnight requirement x 3 or 50%of the total insulin used/24 hrs
    2. Reduce by 20% for safety (reduce by 40% if medically improving rapidly)
    3. Give as Glargine once daily or NPH twice daily (see below)
    4. Adjust basal based on AM glucose
    5. Calculate meal doses using same basal requirement, give short-acting divided among meals (usually B 30%, L 30%, D 40%)
    • If using NPH/regular, can increase AM NPH and give regular just at B, D (shown below, see insulin transition orders)
    • Can give Lispro or Aspart after meal if PO intake uncertain

    If 24 hr requirement unknown, start with 0.6-0.8 units/kg/day

    3 injections a day – NPH in AM, HS, short-acting at breakfast and


    dinner (minimum for Type 1 patients)

    B L D HS

    Basal-Bolus Insulin: Glargine + Short-acting Glargine

    B L D HS

    Prednisone Strategy 1: Increase premeal regular, particularly lunch and


    dinner
    1. Determine 24 hr requirement (e.g., from insulin drip)
    2. Reduce by 20% for safety
    3. Give either Glargine 40% acB OR NPH 25% acB, 15% at HS
    (or determine HS NPH dose by overnight 8 hour insulin drip amt)
    4. Give rapid acting 15% acB, 20% acL, 25% acD
    B L D HS
    Prednisone Strategy 2: AM, noon and hs NPH, premeal short-acting
    1. Determine 8 hr overnight requirement (10 PM-6 AM) and daytime 16 hour requirement (6 AM-10 PM)
    2. Reduce by 20% for safety
    3. Give half of the daytime requirement as NPH, 25% acB and 25% acL
    4. Give the 8 hr overnight requirement as NPH at HS
    5. Give rest as rapid acting in equal doses acB, acL, acD

    B L D HS B L D HS

    If NPO for procedure:’ Give glargine (or ½ NPH), hold short-acting until eating
    Lispro or Aspart

    Glargine

    8 12 6 10

    Supplemental Insulin – See Supplementary Insulin Orders for standard scale


    To calculate individualized scale:
    Calculate sensitivity ratio:
    Determine total daily dose (TDD)
    Sensitivity ratio = 1700/TDD = amount 1 unit of insulin will drop BG
    Adjust supplemental insulin scale based on response to this amt of insulin

    Carb counting
    Calculate Carb:Insulin ratio:
    Determine total daily dose (TDD)
    Carb:Insulin ratio is sensitivity ratio divided by 3 (1700/TDD)/3 = grams of carbohydrate covered by one unit of insulin

    Enteral or parenteral nutrition (continuous)


    Determine 24 hr requirement, give as glargine once (or twice) a day, NPH every 6-8 hours
    Have D5 ready in case nutrition interrupted

    Bolus tube feeds: Give 40% of 24 hr requirement as glargine, 60% as rapid-acting divided equally among boluses

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