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Basal Bolus Insulin Calculator

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University Of Texas–md Anderson Cancer Center

1Department of Endocrine Neoplasia & Hormonal Disorders, Division of Internal Medicine, University of Texas–MD Anderson Cancer Center, Houston, Texas. Background: Hyperglycemia occurs in cancer patients receiving high-dose steroids with cyclophosphamide, doxorubicin, vincristine, and dexamethasone (hyper-CVAD) protocol. The purpose of our study was to determine insulin requirements in patients with hyperglycemia on hyper-CVAD therapy using a systematic algorithm. Subjects and Methods: We did a retrospective chart review of 23 leukemia inpatients with hyperglycemia (two glucose values >250 mg/dL) on hyper-CVAD chemotherapy managed by the Endocrine Diabetes Inpatient Team algorithm. We reviewed demographic and glycemic data, insulin dosages, and use of oral hypoglycemic agents. Using our algorithm, the dose of insulin for each patient was titrated daily and with each subsequent cycle of hyper-CVAD. Results: Ninety-one percent of patients had known diabetes. The median body mass index was 32.5 (range, 21.6–40.9) kg/m2, and median age was 61 (range, 40–80) years. The overall trend in glucose values across cycles showed a statistically significant decrease with each subsequent cyc Continue reading >>

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Popular Questions

  1. obiwan

    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards?

  2. IMtoHO

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? I could be WRONG:
    RISS- no basal given, just boluses to correct sugar qX hours.
    Correction Scale- basal given + correction boluses with first bite.

  3. jdh71

    obiwan said: ↑
    i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
    also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards? Use a drip in the Unit.
    For DKA just follow the algorithm found in pocket medicine. Remember initial bolus dose the rate is 0.1 Units per KG, until the GAP closes, sugars can remain high. Check K often. To reiterate . . . just follow the algorithm.
    Sliding scale is probably sort of an insulin only sugar treatment algorithm similar to what they use for the drips only in sub-q form. And the correction scale is what the nurses give to patient already on medications for anything over and above.
    After 24 hours of sub-q sliding scale insulin, you should know pretty well how much they will need in 24 hours by adding it up, let's 20 Units in 24 hours. I like to take that number and cut in half (10) and give that as long acting insulin at bedtime (glargine or glitiamer usually, whatever us formulary at your institution . . . OR if money for meds is a problem you can cut your half number in half and give as NPH AM and PM [5 and 5]), and the other half gets given as short acting aspart or regular with meals in three divided doses, ie from out current example 3 Units regular or aspart with breakfast, lunch, and dinner. The 6 am blood sugar will tell you if you need to adjust your evening glargine/glitaimer (or alternative the afternoon NPH, and the afternoon blood sugar will tell you how to adjust the morning NPH if that's th regimine you are using)
    Now, you need to hold short acting insulins for NPO status. You're not supposed to need to stop a long acting insulin like glargine or glitiamer for NPO status because these are supposed to control basal sugar metabolism, BUT you'll see people either stopping them altogether or cutting them in half for NPO status.
    Think of sulfonylureas like insulins with regard to dosing and the timing of blood sugars - these medications CAN give you hypoglycemia (some are better for liver or kidney disease, so if you have a liver or kidney patient just double check)
    Metformin is great first line for newly diagnosed DM2's especially if HgbA1c is <8. Metformin will not give you hypoglycemia (though you will run into at least one attending who will sear they've seen it). Hold these for IV contrast procedures - even though in it's current incarnation metabolic acidosis is almost unheard of, we all do it. No metformin in chronic kidney guys as a rule, but some will tolerate fine (use will probably be attending specific in this group)
    In the even of glucose (or sulfonylureal) overdose that will not respond to D50, use a glucagon drip. In these patients giving more glucose only stimulates further intrinsic insulin response. Do not panic, use the glucagon with D50.

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