BASAL BOLUS INSULIN ORDERS THE BASAL BOLUS INSULIN

BASAL BOLUS INSULIN ORDERS

THE BASAL BOLUS INSULIN ORDER SET � The Basal Bolus order set is intended for the management of hospitalized patients with poorly controlled blood glucose (greater than 140 mg/d. L random blood sugar)

CALCULATING DAILY INSULIN Calculating daily insulin • Physicians will be responsible for calculating the dose of the patient’s daily insulin based on the patient’s weight

PHYSICIAN CALCULATION I. Calculation Calculating the daily dose will be as follows: • • Calculate 0. 5 units/kg for average weight Calculate 0. 6 units/kg for obese Calculate 0. 3 units/kg for elderly (greater than 70 years old) Calculate 0. 3 units/kg for patients with renal insufficiency (GFR less than 60 ml/min) II. Distribution • Distribute 50% of daily dose as Basal insulin (Lantus) once per day • Distribute remaining 50% into 3 equal rapid-acting (Humalog) pre-prandial boluses

EXAMPLE Example : An 80 -yr old male was admitted with DM, accucheck shows 160 mg/d. L Step 1 : Calculate DAILY DOSE : 80 kg x 0. 5 units/kg/day = 40 units/day Step 2 : Provide the 50% of the daily dose as BASAL insulin : 40 units/day x 50% = 20 units/day *** 20 units of Lantus will be given once a day (should be given the same time each day) Step 3 : Divide the remaining 50% of the daily dose into 3 equal BOLUS doses Remaining 20 units ÷ 3 = 7 units *** 7 units of Humalog (pre-prandial) to be given 3 times a day Remember : Pre-prandial (Humalog) insulin should be given 0 -15 minutes before meals!

WHAT IF THE PATIENT ISNPO? If patient is NPO: � Reduce the BASAL insulin daily dose by 50% AND � HOLD the pre-prandial insulin

ACCUCHECKS Is there still a need for blood glucose check since patient’s insulin dose is based on weight? � Although insulin doses are already pre-determined daily which is calculated from the patient’s weight, doctors will still order for the blood glucose to be checked on a regular basis

INSULIN SLIDING SCALE Is the Insulin Sliding Scale going away? • NO. During the regularly scheduled blood glucose check, a “supplemental” or “correction” Humalog insulin will still be given depending on the blood glucose result. HOWEVER, instead of the old sliding scale, we will be referring to the new ranges for insulin coverage found in the basal bolus insulin order set). IMPT : Do not hold the “supplemental” or “correction” Humalog insulin even if patient is NPO! (Hold only the pre-prandial bolus doses)

REMEMBER… � Patients may be on basal, pre- prandial and supplemental insulin at the same time. Please provide snack with all PM and HS insulin doses! � In case of hypoglycemia (FSBS <70 mg/d. L), follow standardized procedure

QUESTIONS?