Allergies: Weight: kg Diagnosis:
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1 Page 1 of 4 Allergies: Weight: kg Diagnosis: Service: Attending: Patients with Type 1 diabetes must never be on supplementary insulin alone. Most patients with Type 2 diabetes should have daily regimen as well. All insulin doses must be evaluated daily. Supplementary insulin must NEVER be used with the Insulin Infusion Protocol. Discontinue all previous Insulin and oral hypoglycemic medication orders. Nursing Diet Diabetic (Consistent Carbohydrate) DIET EFFECTIVE NOW CBG (POC) FOUR TIMES DAILY BEFORE MEALS & BEDTIME If NPO or on continuous nutrition, check CBGs q 6 hours at 0000, 0600, 1200, and CBG (POC) Nocturnal at 0200 DAILY Notify MD CBG > 180 for 3 consecutive measurements; CBG < 50 Patients on continuous nutrition If TPN or tube feeds are held for any reason, run D10W at same rate until nutrition restarted IV Fluids Dextrose 10% IV infusion at ml/hr (1-100 ml/hr) AS NEEDED FOR parenteral/enteral nutrition interruption Patients on continuous nutrition if TPN or tube feeds are held for any reason, run D10W at same rate until nutrition restarted INSULIN Choose a basal and a scheduled mealtime insulin Basal Insulin Patients who are eating (single select) Insulin glargine is the preferred insulin for basal insulin insulin glargine (aka LANTUS) injection Units, Subcutaneous, AT BEDTIME For CBG < 70, decrease scheduled Insulin by 2 Units insulin NPH (aka HUMULIN N, NOVOLIN N) injection Units, Subcutaneous, BEFORE BREAKFAST AND BEDTIME For CBG < 70, decrease scheduled Insulin by 2 Units
2 Page 2 of 4 Scheduled Mealtime Insulin Patients who are eating Insulin lispro is the preferred insulin for scheduled mealtime insulin. insulin lispro (aka HUMALOG) injection Units, Subcutaneous, THREE TIMES DAILY WITH MEALS Scheduled mealtime insulin - do not give mealtime insulin if patient not eating. Patient consistently eating Administer 10 minutes before eating. Patients with variable eating Administer after eating. If less than 50% of the meal is eaten, give 1/2 of the scheduled insulin dose. Enteral Nutrition For patients on continuous nutrition, NPH given Q 8 hours is the preferred regimen. For patients on overnight nutrition, use NPH given at the start of the nutrition. Patient may also need basal insulin and scheduled mealtime insulin if eating. For patients on bolus nutrition, lispro given with each tube feed bolus is preferred. Patient may also need basal insulin. Consider glargine as an alternative to NPH for patients on continuous nutrition or as basal insulin for patients on overnight or bolus nutrition. [Patient on continuous nutrition] insulin NPH (aka NOVOLIN N) injection Units, Subcutaneous, EVERY 8 HOURS [Patient on overnight nutrition] insulin NPH (aka NOVOLIN N) injection EVERY EVENING Administer at onset of tube feeds. [Patient on bolus nutrition] insulin lispro (aka HUMALOG) injection FIVE TIMES DAILY Administer with each tube feed bolus. insulin glargine (aka LANTUS) injection Units, Subcutaneous, Units, Subcutaneous, Units, Subcutaneous, AT BEDTIME Insulin Mealtime Correction Do not order correction insulin if patient is on an insulin infusion. Insulin lispro is the preferred form of insulin for mealtime correction. Mild Scale Moderate scale Aggressive Scale Thin Elderly Renal Insufficiency Type 1 diabetes on under 30 units total insulin per day Majority of patients Steroids Infection Insulin resistance
3 Page 3 of 4 See attached Supplementary Insulin Correction Protocol insulin lispro (aka HUMALOG) injection 1-16 Units, Subcutaneous, WITH MEALS AND BEDTIME Mealtime insulin correction administer as directed in addition to scheduled Insulin (in same injection). Meal Correction Insulin Dose: (choose scale) Mild Scale Moderate Scale Aggressive Scale Custom Scale Mealtime or Continuous Nutrition Bedtime NPO Correction dose insulin should NOT be given with an insulin infusion
4 HYPOGLYCEMIA Hypoglycemia Page 4 of 4 See Adult Hypoglycemia Treatment Policy Hypoglycemia Protocol Adult Institute for CBG < 70 mg/dl. dextrose 50% (aka D50W) IV 25 ml, Intravenous, AS NEEDED for hypoglycemia, CBG < 70 mg/dl. -If patient unable to take PO, administer by slow IV push, followed by a flush with 5 ml of normal saline (hypertonic solution that can cause sclerosis of the vein if not flushed). -Please refer to Adult Hypoglycemia Protocol. glucagon (aka GLUCAGEN) IM injection 1 mg, Intramuscular, AS NEEDED for hypoglycemia, CBG < 70 mg/dl. Please refer to Adult Hypoglycemia Protocol. glucose chewable tablets 16 g, Oral, EVERY 15 MINUTES AS NEEDED for hypoglycemia, CBG < 70 mg/dl. Administer for CBG 70mg/dL. Please follow Adult Hypoglycemia Protocol.
5 Adult Supplementary Insulin Correction Protocol Correction Insulin should be administered in addition to scheduled Insulin. Correction Insulin should not be given to patients who are on Insulin Infusions. Insulin Mealtime or Continuous Nutrition Correction Dose No Correction unit 2 units 4 units units 4 units 6 units units 6 units 10 units units 8 units 12 units units 10 units 16 units Insulin Bedtime Correction Dose (Patient Who is Eating) < 141 No Correction No correction 1 unit 2 units unit 2 units 3 units units 3 units 5 units units 4 units 7 units units 5 units 12 units Insulin for NPO < 141 No Correction unit 1 unit 4 units units 3 units 5 units units 4 units 6 units units 5 units 8 units units 6 units 10 units ONLINE 2/27/2013 accompanies PO-1760 DO NOT SCAN
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