Alex’s notes

1. If the patient has a known, home, long-acting insulin dose, use that.
2. If the patient is insulin naïve, can start with 0.25 units/kg of Lantus
1. If not eating, can give 0.08 units/kg (about 1/3 of the above dose) with each meal.
2. I assume that sliding scale would be in addition to such dosing.

 

One recommendation

1. Calculate patients total daily dose (TDD) of insulin:
1. Average the insulin infusion rate (units/hr) over the last 4-6 hrs
2. Extrapolate the rate over 24 hrs
1. For instance, if infusion rate over the last 4 hrs was: 3 units/hr, 4 units/hr, 5 units/hr, and 4 units/hr, average is 4 units/hr.
2. Multiply that average hourly rate by 24, so 4 x 24 = 96.
3. My note: I don’t see why couldn’t add the rate over the last 4 hours and multiply by six. So in the above example:
   (3 + 4 + 5 + 4) * 6 = 16 * 6 = 96
   Or add the amounts over the last 6 hrs and multiply by 4. You get the idea.
2. Reduce the calculate dose by 20% to account for changes in insulin formulation and to avoid hypoglycemia.
1. So in our example: 96 * 0.8 = 76.8 or 77 units
3. Patients on insulin therapy typically require basal and bolus dosing of insulin. To account for these two types of insulin dosing, divide the calculated TDD by two. This will give the basal dose.
1. So, 77 units/day / 2 = 38.5 which they round to 38 units. This represents the Lantus (or the TDD of NPH) to administer to the patient.
4. Some patients may not be ready to eat. In those cases, administer the basal insulin and order a sliding scale but hold off on the scheduled bolus dosing until the patient is eating reliably.
5. The patient is eating reliably, you can initiate the scheduled bolus dosing with meals. To calculate this dose take the remaining 50% of the TDD and divide it by 3 since there are 3 meals in the day.
1. From our example, the remaining 50% of the TDD is 77 units/day / 2 = 38.
2. 38 / 3 = 12.67 which can round to 13 units of insulin per meal.