Transition from IV to SQ Insulin Protocol (Pilot)
(This protocol applies only to patients on an insulin drip for >24 hours.
Physician to make a clinical judgment on all others.)
Yes:
All patients with type 1 DM
All patients with Type 2 Diabetes and recent
mean infusion rate > 1.0 unit / hour
All patients with stress hyperglycemia or
unrecognized DM, a recent mean infusion rate > 1.0
units/hr, AND a Hgb A1c > 6.0%
All patients on > 60 mg of prednisone/day or
equivalent AND an infusion rate > 1.0 units/hr. (Taper
insulin to match steroid taper. This doe NOT include
patients on stress dose steroids for spinal injuries.)
No:
Type 2 diabetics with a recent mean infusion
rate of < 1.0 units/hr
Stress hyperglycemia with a HgbA1c < 6.0%
No: Order correction insulin (sliding scale). Stop here.
Yes:
50% TDD = basal insulin ordered as Lantus QD
50% TDD = nutritional insulin divided TID if tolerating meals (Lispro) or Q6 hours if on
continuous tube feeds (Regular).
Full nutrition: Pt is eating >50% of their meals, on goal
tube feeds, or on TPN.
Step A: Average the rate of insulin infusion over the
previous 6 hrs
Step B: Multiply this number by 20
(avg drip rate) _____ units/hr X 20 = _____ = TDD
Step 2: Evaluate the patient’s nutritional intake to calculate the
Total Daily Dose (TDD) of insulin.
OR
Minimal nutrition: Pt is NPO, taking <50% of their
meals, or is on a clear liquid diet.
Step A: Average the rate of insulin infusion over the
previous 6 hrs
Step B: Multiply this number by 40
(avg drip rate) _____ units/hr X 40 = _____ = TDD
Step 3: Divide the TDD into the appropriate components of insulin treatment (basal, nutritional and
correction), depending on the nutritional situation.
Watch Out!!!
Do NOT exceed a TDD of 100 units/day unless the patient was previously on >100 units of insulin/day.
Re-evaluate and adjust the TDD every day.
Call the “glycemic control” pager with all questions regarding this insulin transition protocol: 290-XXX.