A1c:

0 mg/dL

ft: 0 1 2 3 4 5 6 7 8 9 in: 0 1 2 3 4 5 6 7 8 9 10 11 Weight: kg: lb:

0 Body Mass Index

Hypoglycemia is commonly over-treated.
IV dextrose should only be used if mental status is altered or patient is NPO.

• Standard treatment:
  • 15 gm glucose = 1 tube Glutose gel
    - OR -
  • 4 oz juice/non-diet soda drink.

• For NPO patient:
  • 25 mL dextrose 50% IV.

Repeat BG in 15 minutes. Protocol allows RN to initiate treatment as a verbal order of the licensed independent practitioner (LIP) prior to actually notifying the LIP.

This link will take you away from this program opening a PDF:
Insulins table

Class	Name	Brand	Via	Rx/OTC	Onset	Peak	Duration	Price* Source
								10ml Vial	5x3ml Pen Cartridge
Rapid Acting	Aspart	Novolog		Rx	5-15 min	1-2 hr	3-5 hr	$102	$205
	Lispro	Humalog		Rx				$96	$183
	Glulisine	Apidra		Rx				$96	$184
Short Acting	Regular	Novolin R		OTC	30-60 min	2-4 hr	4-8 hr	$53	$121
		Humulin R		OTC
Intermediate Acting	NPH	Novolin N		OTC	2-4 hr	7-8 hr	10-18 hr	$52	$121
		Humulin N		OTC
Long acting	Glargine	Lantus		Rx	2-4 hr	None	24 hr	$97	$177
	Detemir	Levemir		Rx				$95	$182
Premixed†	NPH /Regular	Novolin 70/30		OTC	30-60 min	??	10-18 hr	$54	$135
		Humulin 70/30		OTC
		Humulin 50/50		OTC
	NPH /Aspart	Novolog Mix 70/30		Rx	5-15 min	1-2 hr	10-18 hr	$105	$200
	NPH /Lispro	Humulog Mix 50/50		Rx
		Humalog Mix 70/30		Rx

† Not recommended for inpatients; not easily titrated. Recommend switching to a basal-bolus insulin regimen for hospital stay.
* Approximate

1. Umpierrez, G. E. et al. Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism 97, 16–38 (2012).
2. Braithwaite, S., Clark, L., Dacenko-Grawe, L. & Devi, R. Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry. Diabetes – Damages and Treatments 183–206 (2011).
3. Johns Hopkins Glucose Management Committee. PRESCRIBER TOOLS FOR INPATIENT DIABETES MANAGEMENT [Internet]. 2010. Available from: http://www.netorthodoc.org/DiabetesMgmtBooklet8pages.pdf
4. Inzucchi SE. Management of Hyperglycemia in the Hospital Setting. New England Journal of Medicine 2006
5. Maynard G, Lee J, Phillips G, Fink E, Renvall M. Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. Journal of hospital medicine (Online) 2009;4(1):3–15.
6. Barnard K, Batch BC, Lien LF. Subcutaneous Insulin: A Guide for Dosing Regimens in the Hospital. Glycemic Control in the Hospitalized Patient 2011;:7–16.
7. Korytkowski MT, Salata RJ, Koerbel GL, et al. Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy: A randomized controlled clinical trial. Diabetes Care 2009;32(4):594–6.
8. Magaji V. Inpatient Management of Hyperglycemia and Diabetes. Clinical Diabetes 29, 3-9 2011.
9. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med 2011;154(4):268–82.
10. Bhargava A, Johnson JF, Weir JP. Case Series: Premixed Insulin Dosing in Actual Practice: Two-Thirds in AM, One-Third in PM, or Half and Half? Clinical Diabetes 2009;27(2):91–5.
11. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364–79.