How to overlap SC insulin bolus with IVI insulin?
✎ Time: 30 mins before stopping IVI insulin (for insulin analogues) // 1 hour before stopping IVI insulin (for human insulin, e.g. Actrapid)
Notes: IVI insulin continued for 30 mins (insulin analogues) – 1 hour (human insulin) to prevent rebound hyperglycaemia
✎Regimen
• If patient is already on basal bolus insulin prior to admission, consider resuming previous insulin regimen and adjust dose as needed, otherwise,
• Estimate total daily dose (TDD): 0.5 – 0.75 units × bodyweight, then
• Give 50% of the TDD for bedtime, i.e. long-acting insulin, then
• The remaining 50% is divided equally by 3 (pre-breakfast, pre-lunch, pre-dinner meals)
Notes:
– 0.75 units/kg/day is for patients considered to be more insulin resistant e.g. obese, presence of acanthosis nigricans
• Current practice is shifting away from estimating total daily dose (TDD) of SC Insulin based on last 12 – 24 hours insulin administered
Example:
Bodyweight = 60 kg
TDD = 60 × 0.5 = 30 units per day
• 30/2 – 15 units
• SC Insulatard 15 units ON
• SC Actrapid 5 units TDS (i.e. 15/3 = 5 units)
Let’s say lunch at 12 pm
• Administer SC Actrapid 6 units at 11.30 am
• Lunch at 12 pm
• Off IVI Actrapid at 12.30 pm