General Considerations for the Provision of Insulin Coverage
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In general, the total daily insulin requirement can be based on the patient’s prior insulin dose or as 0.6 units/kg/day. Basal insulin is the amount of exogenous insulin per unit of time needed to prevent unchecked gluconeogenesis and ketosis. Basal insulin is generally provided either as NPH insulin twice daily or as insulin glargine once daily. The prandial insulin requirement is the amount of insulin needed to cover the glycemic excursion that follows ingestion of food/meals. Supplemental or correction insulin is used to meet insulin requirement in excess of the basal plus prandial needs that may result from the stress response to illness or a procedure, or to iatrogenic factors such as steroid therapy. Supplemental/correction doses are provided in the form of aspart, lispro, or regular insulin and are given in addition to the programmed basal and/or prandial insulin doses. Case 2 of this eGrand Rounds provides further details.
Using a sliding-scale method for longer than 24 to 48 hours to determine insulin requirements is generally not recommended, as this practice is clearly associated with an increased risk for both hypoglycemia and hyperglycemia. Case 1 and Case 2 of this activity offer additional discussion of the use of sliding-scale insulin.
