By vgreene, 20 February, 2018 If bolus tube feed: Give insulin immediately before or immediately after nutrition delivery8
By vgreene, 20 February, 2018 Diet: consistent controlled carbs. Snacks not automatically required; offer low/no carb snacks, additional nutritional insulin coverage may be needed for carb-containing snacks
By vgreene, 20 February, 2018 Consider pumps/infusions. Consider insulin infusion if uncontrolled hyperglycemia on steroids3 or TPN, hyperglycemic crisis, or L&D. If T1DM managed on insulin pump as outpt, consider continuing as inpt if criteria met.10 If pregnant: OK to continue insul
By vgreene, 20 February, 2018 Basal + nutritional + correction insulin; aim for BG 100-180 for most pts;1 adjust for nutrition; stop noninsulin antihyperglycemics. ✓A1c2
By vgreene, 20 February, 2018 Adjust daily: Add up previous day’s correction insulin, redistribute equally to basal and nutritional doses. If any BG >180 w/ no hypoglycemia threat, increase total daily dose by 10%-20%; if BG consistently >180-200, increase total daily dose by 30%. If
By vgreene, 20 February, 2018 ✓BG 4x/day: qac, qhs. Repeat ✓ if meal not delivered w/in 30min of premeal BG ✓
By vgreene, 20 February, 2018 Correctional: Specify correction9 rapid-acting SC insulin (eg, lispro) based on estimated insulin sensitivity
By vgreene, 20 February, 2018 Nutritional: Rapid-acting6 (eg, lispro) preferred; give w/in 15min of 1st bite of meal or bolus start. If nausea/poor appetite, adjust insulin timing by up to 30min and account for portion of meal8
By vgreene, 20 February, 2018 Basal: Insulin glargine or detemir preferred for once-daily basal in nonpregnant 7 pts
