| name | es-continue-scheduled-insulin-modified |
| description | Recommend continuation of the pre‑admission scheduled insulin regimen, adjusted for nutritional status and severity of illness, to keep glucose between 100‑180 mg/dL in hospitalized adults with insulin‑treated diabetes. Triggered by clinician questions such as “Patient was on insulin before admission, how should we adjust their regimen in hospital?” or similar. |
Continue scheduled insulin regimen modified for nutritional status and severity of illness in patients with insulin-treated diabetes prior to admission
STEP 1 — Gather Information
Collect the patient’s pre‑admission insulin regimen (type, dose, schedule), current nutritional intake (percentage of meals, NPO, enteral feeds), markers of illness severity (e.g., infection, steroids, organ dysfunction), and recent point‑of‑care glucose values.
STEP 2 — Rule In / Rule Out
If the patient has insulin‑treated diabetes prior to admission and is hospitalized for a noncritical illness → proceed to Step 3; otherwise, consider alternative glycemic strategies (e.g., correctional insulin alone) and discontinue this pathway.
STEP 3 — Classify or Stratify
Stratify by nutritional status (≥75% meals, 25‑75% meals, <25% meals/NPO/enteral) and illness severity (mild vs moderate/severe); for basal‑heavy regimens (≥0.6 U/kg/day basal) with reduced intake or catabolic illness, plan to reduce basal insulin dose by 10‑20%.
STEP 4 — Decide
Continue the scheduled insulin regimen with the calculated dose adjustments; prescribe glucose monitoring before meals and at bedtime; adjust prandial or correctional insulin as needed to maintain glucose targets of 100‑180 mg/dL.
Clinical Guardrails / Mimics / Pitfalls
Avoid using sliding‑scale insulin alone; do not increase basal insulin in patients with reduced oral intake; monitor closely for hypoglycemia, especially in renal impairment or when NPO; do not discontinue basal insulin abruptly; reassess doses daily based on glucose trends and clinical changes.
Concrete Clinical Example
A 68‑year‑old woman with type 2 diabetes on basal‑bolus insulin (glargine 24 U nightly, aspart 6 U TID) is admitted for mild cellulitis (noncritical). She eats about half her meals. Continue glargine at 20 U (≈‑15 %) and aspart 6 U with meals; check AC and HS glucose; aim for 100‑180 mg/dL.
Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278
