According to the Georgia Hospital Association protocol for IV insulin therapy, how is the patient transitioned to subcutaneous insulin?

Updated: Nov 06, 2018
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

Transition to subcutaneous insulin is as follows:

  • Blood glucose levels should be within target range for at least 4 hours before intravenous insulin is discontinued.

  • Calculate total daily insulin (TDI). The formula is: Units of insulin for the last 2 hours of intravenous drip x 12 for patients on D5W.

  • Begin glargine is equal to 50% TDI (for pregnant patients, use neutral protamine Hagedorn twice daily).

  • Begin fast acting analog is equal to 50% of TDI divided by 3 (give 3 times a day immediately after meals).

  • Continue intravenous insulin infusion for 2 hours after initiation of subcutaneous therapy.

  • Refer to subcutaneous transition orders for administration times and dosage adjustments.

  • Refer the patient for diabetes education, nutritional services, and discharge planning to ensure the patient can afford the medications and supplies and has follow-up disease state management after discharge.


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