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548 Initiation & Intensification of Insulin Therapy in T2DM

I.P. HYPERGLYCEMIA

INPATIENT GLUCOSE TARGETS FOR NONPREGNANT ADULTS
Hospital Unit Treatment Goal

Intensive/critical care. Glucose range, mg/dL 140 – 180
General medicine and surgery, non-ICU

Premeal glucose, mg/dL < 140
Random glucose, mg/dL < 180

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INSULIN INFUSION STARTING DOSE(I.I.T.)
1. Starting dose for unstressed Normoglycemic adult with average BMI 1-2u/hr

2. (OR) 50% of previous Day’s TDD/24 Hours (Eg: TDD = 90u ! 50 % TDD = 45u ! 45/24 = 2u/Hr)
3. DKA, Steroid induced hyperglycemia may require higher infusion rates(5-7u/hr)

TITRATION OF INSULIN INFUSION RATE
1. Insulin action lasts approximately 1 hour
2. Meticulous Hourly Monitoring & Titration of BG
3. IF BG 400 mg% Starting dose 2u / Hr

4. Increase dose rate if BG does not reduce 30 – 50 mg/dL after 1 hour
5. Reduce the rate if BG drops > 30-50mg/dL after 1 hour
6. Continue insulin infusion till oral intake or improvement in general health condition

GCDC 2017