Correction Insulin Dosing for Severe Hyperglycemia

Immediate Correction Dose Calculation

• For insulin-naive patients, a reasonable starting assumption is an insulin sensitivity factor (ISF) of approximately 30-50 mg/dL per unit of insulin, which is used to calculate the correction insulin dose, depending on the patient's total daily insulin dose (TDD) 1

Standard Correction Scale for Hospitalized Patients

• For blood glucose 261-300 mg/dL, 6 units of rapid-acting insulin should be administered 2
• For blood glucose >300 mg/dL, 8 units of rapid-acting insulin should be administered and the physician should be notified 2

Monitoring and Titration Requirements

• Blood glucose should be checked every 6 hours minimum, or before meals if eating, with a target blood glucose of 140-180 mg/dL in hospitalized patients 2
• Basal insulin should be adjusted by 2-4 units every 3 days based on fasting glucose patterns, with increases of 4 units if fasting glucose ≥180 mg/dL, 2 units if fasting glucose 140-179 mg/dL, and decreases of 2 units if fasting glucose <80 mg/dL on more than 2 occasions 3, 1

Special Considerations for High-Risk Patients

• For elderly patients (>65 years), those with renal failure, or poor oral intake, lower doses of 0.1-0.25 units/kg/day should be used to prevent hypoglycemia, with proportional reduction in correction dose 1
• If the patient is on high-dose glucocorticoids, insulin requirements increase by 0.3-0.4 units/kg/day, with 75% given as prandial insulin and 25% as basal insulin, and more frequent blood glucose monitoring is recommended 2

Why Basal-Bolus is Superior to Sliding Scale Alone

• Scheduled basal-bolus insulin regimens reduce hypoglycemia by 50% and achieve 75% of blood glucose measurements in target range, compared to only 61% with sliding scale insulin, according to the American Diabetes Association 3