Physician'S Orders Adult Subcutaneous Insulin Order Sheet (Page 2 of 2) in pdf

Adult Subcutaneous Insulin Order Sheet

This new order sheet has been developed to standardize and improve the treatment of diabetes patients while in the

hospital. It was developed by an interdisciplinary team utilizing current treatment concepts based on the literature as

well as experience in similar projects at other academic medical centers. We have tried to design this form to be easy

to use and also to serve as an educational tool to improve the care of our diabetic patients.

PROOF ONLY

Scheduled Insulin:

Current concepts of insulin therapy look at basal needs and needs for food (prandial). Basal needs continue in the

hospital, but food intake may change. In addition, stress and inactivity may increase insulin needs. It is currently

REV 12/6/05

recommended that patients who are going to be eating continue on their FULL home dose unless they are

demonstrated to need a change. Patients who are NPO need their full BASAL insulin. If the patient uses NPH,

Ultralente, or a combination for their basal and prandial needs, we estimate their basal as 50% of the total and give

it as NPH (or Ultralente). E.g. a patient on Novolin 70/30, 20 units with breakfast and 10 units with supper who was

NPO would start at 10 units NPH in the AM and 5 units NPH in the PM.

Correction Insulin:

Sliding Scale Insulin (SSI) is useful as a supplement to an underlying program for the treatment of diabetes. It is not

effective as a replacement to basal therapy. It should be looked at as treatment for deviation from desired values

caused by illness. Therefore, it is generally more appropriate to use a rapid acting insulin such as Novolog (or

Humalog) rather than regular as this supplement. Rapid acting insulin corrects the sugar faster and then “goes away”

leading to less risk of insulin accumulation and hypoglycemia. There is not one scale that fits all for SSI. The optimal

dosing depends on the sensitivity of the individual patient to insulin. This sensitivity is best estimated by Total Daily

Dose of insulin for those who have been insulin treated at home. Otherwise the best estimate is by body habitus.

Serious infections and the use of steroids increase the insulin needs.

It is desirable to adjust the scheduled insulin and/or the SSI when the blood sugars are not at target.

Reference: Endocrine Practice 2004, v10:supl 2, 1-108

Insulin Characteristics

Type

Generic

Brand

Onset

Peak

Duration

Comments

Rapid

Aspart

NovoLOG

10-30 min

-3 hour

3-5 hour

Lisporo

HumaLOG

Glulisine

Adipra

Regular Insulin

NovoLIN R

Short

30-60 min

2-5 hour

5-8 hour

HumuLIN R

Intermediate

NPH Insulin

NovoLIN N

1-3 hour

4-12 hour

18-26 hour

Lente Insulin

HumuLIN N

HumuLIN L

Data is based on beef Ultralente,

Long

4-6 hour

8-30 hour

24-36 hour

Ultra Lente

HumuLIN U

Human Ultralente appears closer

to intermediate acting insulins

Peakless

Glargine

Lantus

1-4 hour

None

> 24 hour

Premix of NPH and Regular

Mix (Standard)

NovoLIN 70/30

insulins

HumuLIN 70/30

HumuLIN 50/50

Mix (Analog)

NovoLOG 70/30

Premix of Analog intermediate

HumaLOG 75/25

and rapid

The times are based on data provided by manufacturers. The onset may be delayed and the duration prolonged by poor circulation

to the injection site and by antibodies. UMass Memorial Medical Center preferred agents are in bold type.

Physician'S Orders Adult Subcutaneous Insulin Order Sheet Page 2

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