Glycemic Management
Dose Adjustments

Dose Adjustments

Note

Patient should generally have received at least 12 to 24 hours of currently ordered insulin regimen prior to adjustments

Changes in patient status or medications may require adjustment less than 12 hours after initiation of regimen

Basal Insulin (insulin glargine)

Adjust basal insulin regimen based on fasting blood glucose

Fasting Blood Glucose (mg/dL) Basal Insulin Dose Adjustment
<70 Decrease by 20%
70-100 Decrease by 10%
100-180 No change
180-250 Increase by 10% AND add 50% of correction within previous 24 hrs
250-350 Increase by 15% AND add 50% of correction within previous 24 hrs
>350 Increase by 20% AND add 50% of correction within previous 24 hrs
  • Give bridge dose of NPH now
    • Bridge dose NPH units = (New insulin glargine dose in units – previous insulin glargine dose in units) * 50%
  • Initiate new dose of insulin glargine at 2200

Bolus Insulin (insulin lispro)

Adjust bolus/pre-prandial insulin regimen based on average pre-prandial blood glucose

Divide new total bolus insulin into 3 even doses (scheduled with meals)

Average Pre-Prandial Blood Glucose (mg/dL) Total Bolus Insulin Dose Adjustment
<70 Decrease by 20%
70-100 Decrease by 10%
100-180 No change
180-250 Increase by 10% AND add 50% of correction within previous 24 hrs
250-350 Increase by 15% AND add 50% of correction within previous 24 hrs
>350 Increase by 20% AND add 50% of correction within previous 24 hrs

Calculate New TDD

Add total bolus doses and total basal dose

New TDD should NOT exceed 25% increase from previous TDD

More Information

  • Umpierrez GE, Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes.
  • Umpierrez GE, Randomized study of basal-bolus insulin therapy in inpatient management of patients with type 2 diabetes undergoing general surgery. Diabetes Care. 2011;34:256-261.
  • Umpierrez GE, Randomized study comparing a basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes. Diabetes care. 2013;36:2169-2174.
  • Maynard G, Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. J Hosp Med. 2009;4(1):3-15.
  • Grommesh B, Hospital insulin protocol aims for glucose control in glucocorticoid-induced hyperglycemia. Endocr Pract. 2016;22(2):180-189.