Inpatient Diabetes

---

If you want to avoid the laborious process listed in this chapter, here is a masterpiece of a calculator I coded:

---

Remember, sliding scales are TERRIBLE

On admission

• Hold oral agents and place on insulin
• If already on home insulin, may not need to stop

When on insulin

• Avoid hypo/hyperglycemia extremes
• Hypoglycemia- AMS, confusion
• Hyperglycemia- delayed wound healing, infection risk, longer stay, longer/ delayed procedures

Goals

• Treat when BG's>140s and persistent
• ICU: goal 140-180
• Non-ICU goal: premeal (100-140)
• Random Non-ICU goal: 100-180

Insulins

• Lispro: short-acting, used in pre-meal and sliding scales
• Regular: usually not used
• NPH: 5-7 hours--> used if you anticipate increase in BGL (steroids)
• Glargine/Lantus: Basal/long-acting for 24H

Insulin Experienced

• ICU ill: goal 140-180--> often require insulin drip
• Not critically ill: BG<140. Do 25-50% of home dose if well-controlled

Insulin naïve

---

Example, in case you are confused as I was for years:

47 yo male obese (270kg) with T2DM and A1c is 12, not critically ill. Calculate his insulin dose?

• TDD: 270kg * 0.6=0.6 162U of insulin
• Daily basal bolus: 81U basal (long-acting) and 81U bolus (pre-meal)
• 81U bolus/ 3 meals a day= 27U pre-meal
• Sliding scale: high dose
• Final regimen: 81U basal + 27U pre-meal TID + high dose sliding scale for pre-meal correction
• Daily check of sliding scale to see how you do
  • i.e. 12U of insulin premeal correction needed before each meal= 12 * 3 meals= 36U of insulin
  • Total daily insulin need= 162 U insulin +36=36 198U
    • New regimen= 99U basal + 33U TID

Correctional scale
Glucose Range	Insulin (lispro)
<140	0
141-180	2
181-220	4
221-260	6
261-300	8
301-340	10
>340	12