Twice daily insulin titration

Diabetes & endocrinology
NHS Lothian

 

  • Check capillary blood glucose (CBG) four times per day in inpatients
    • target for most is 6-12 mmol/l
  • Humulin M3, Novomix 30, Humalog Mix25 and Humalog Mix50 are once or more commonly twice daily pre-mixed insulins
  • Insulatard, levemir and humulin I last around 12 - 24hrs (once or twice a day)
  • Review CBGs daily and prescribe insulin on ward round
  • Increase insulin every 24 - 48hrs if pre-meal CBGs are above target
  • If any hypoglycaemic events, insulin should be reduced

CBG <4mmol/L on a single occasion

Treat hypo as per protocol

CBG <4mmol/l pre-lunch or pre-dinner

CBG <4mmol/l pre-bed or pre-breakfast

If CBG 3-4 mmol/l, reduce AM insulin by 10%

If CBG <3mmol/l, reduce AM insulin by 20%

Reduce evening meal insulin by 20%

 

CBG >12 mmol/L for >48hrs or CBG >18 mmol/L for >24hrs

If CBG >14 and T1DM check capillary ketones, if >1mmol/l call senior or diabetes team if in hours

CBG >12 mmol/l pre-lunch or pre-dinner

CBG >12 mmol/l pre-bed or pre-breakfast

CBG >12mmol, increase morning insulin by 10%

If CBG >18mmol/l increase morning insulin by 20%

CBG >12mmol, increase evening meal insulin by 10%    

If CBG >18mmol/l increase evening meal insulin by 20%