Insulin, Subcutaneous NPO or Continuous Enteral Feeding Orders

Target Inpatient
Blood Glucose
Levels: All
preprandial 100-
140 mg/dL, all
random 30), or those receiving high doses or corticosteroids – use 0.5 units/
kg/day (or more).
Step 3: Determine the distribution of the TDD calculated above based on nutritional regimen.
Note: if basal insulin exceeds 50% of the TDD, the pt is at higher risk for hypoglycemia for
longer periods of time if the nutrition source is stopped.
If patient receiving continuous infusions of tube feeds:
If patient NPO :
Check blood glucose every 6 hours.
Check blood glucose every 6 hours.
Basal insulin: Glargine (Lantus®) = 0.5 x TDD, given once daily,
Start low dose dextrose infusion (D5 0.45% NaCl at 75 mL/hr) if no
dosed at bedtime.
other dextrose infusion running.
Nutritional insulin: Regular insulin = give the remainder of the TDD in Basal insulin: Glargine (Lantus®) = 0.5 x TDD, given once daily, dosed
4 equally divided doses Q 6 hrs, if rate of tube feed is 40 mL/hr. at bedtime.
Correctional insulin, in addition to nutritional insulin: Use very
Nutritional insulin: None (discontinue previous).
low (Known severe insulin sensitivity), low (Insulin sensitive: lean, Correctional insulin: Consider use of very low or low dose algorithm.
malnourished, elderly, kidney disease) moderate (Not insulin
Adjust based on insulin requirements.
sensitive/not insulin resistant: average weight) or high (Likely insulin
resistant: obese, receiving high dose corticosteroids) dose or custom
algorithm based on BMI and/or insulin requirements.
Step 4: Evaluate the insulin dose DAILY. Determine the total dose received for the previous day and adjust.
If any glucose >180 mg/dL and no hypoglycemia increase TDD by 10%.
If any glucose < 100 mg/dL) decrease TDD by 10%.
If any episodes hypoglycemia (glucose < 70 mg/dL) decrease TDD by 20%.
Discharge Considerations
Based on admission A1C
• A1C < 7% give insulin in hospital but at discharge consider return to preadmission medication.
• A1C 7-8% increase dose of home oral agents or insulin, add a third agent, or add basal insulin.
• A1C >8% continue orals and add/increase basal insulin.
• A1C >9% use basal bolus insulin regimen.
If patient has history of hyperglycemia in hospital follow up with PCP to evaluate (BG>180).
Backer Page of 1 100-7071-202SW (3/10/11)