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New correctional insulin scales coming soon

By Sandra Bunn, diabetes clinical nurse specialist

The Salem Health Pharmacy and Therapeutics Committee has approved new, evidence-based insulin correction scales to go live June 28.

General recommendations from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists indicate best practice for hospitalized patients includes the use of correctional insulin to reach target glucose without inducing hypoglycemia. In order to protect our patients from potentially dangerous hypoglycemia, the new standard correction scales (mild, moderate and severe) will start at 140 mg/dL (as listed below) compared to the current correction scale starting at 110 mg/dL. A custom correction scale is still available in EPIC for more closely fine-tuning insulin dosing.

 

Blood glucose level

Insulin sensitive dosing (MILD)

Standard dosing

(MODERATE)

Insulin resistant dosing (AGGRESSIVE)

141 - 180 mg/dL

2 unit

4 unit

6 units

181 - 220 mg/dL

4 units

6 units

8 units

221 - 260 mg/dL

6 units

8 units

10 units

261 - 300 mg/dL

8 units

10 units

12 units

301 - 350 mg/dL

10 units

12 units

15 units

351 – 400 mg/dL

12 units

14 units

16 units

Over 400 mg/dL

14 units & call MD

16 units & call MD

18 units & call MD

 

This will only affect new orders for correction bolus insulin – existing orders will remain with the current scale until they are changed by a provider.

For questions or concerns, please contact Sandra Bunn (diabetes CNS), Michelle Grove (glycemic management NP) or Matt Tanner, MD. 

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