Insulin Therapy for Hyperglycemia Correction

Recommended Insulin Scale

For patients with blood glucose levels < 5.5 mmol/L, no correction insulin is administered 1
For patients with blood glucose levels between 5.5-8.3 mmol/L, 2 units of rapid insulin are administered 1, 2
For patients with blood glucose levels between 8.4-11.1 mmol/L, 4 units of rapid insulin are administered 1, 2
For patients with blood glucose levels between 11.2-13.9 mmol/L, 6 units of rapid insulin are administered 1, 2
For patients with blood glucose levels between 14.0-16.7 mmol/L, 8 units of rapid insulin are administered 1, 2
For patients with blood glucose levels between 16.8-19.4 mmol/L, 10 units of rapid insulin are administered 1, 2
For patients with blood glucose levels > 19.4 mmol/L, 12 units of rapid insulin are administered and the physician should be contacted 1, 2

For insulin-sensitive patients, the insulin dose should be reduced by 50% 1, 3
For insulin-resistant patients, the insulin dose should be increased by 50-100% 1, 3

For fasting patients, rapid insulin should be administered every 4-6 hours as needed 2
For patients on enteral nutrition, rapid insulin should be administered every 4-6 hours 2

The rapid insulin scale should ideally be used in combination with basal insulin (such as glargine or detemir) 1, 4
Using a rapid insulin scale alone (without basal insulin) is associated with suboptimal glycemic control and is not recommended for most diabetic patients 1, 2

Close monitoring for signs of hypoglycemia is essential, as it is the primary adverse effect of insulin therapy 1, 5
The basal-bolus approach is associated with a 4-6 times higher risk of hypoglycemia compared to using a simple insulin scale alone 1
Rapid insulin should be avoided at bedtime to prevent nocturnal hypoglycemia 5