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.