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Building and Implementing Effective Subcutaneous Insulin Orders and Protocols

Insulin Terminology. Basal insulinLong-acting, all Type 1 and most Type 2 DM patients should have basal insulin whether they are eating or not (insulin glargine, insulin detemir, or NPH)Nutritional or pre-meal / prandial insulinShort-acting insulin given with meals in anticipation of carbohydrate

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Building and Implementing Effective Subcutaneous Insulin Orders and Protocols

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    1. Building and Implementing Effective Subcutaneous Insulin Orders and Protocols Greg Maynard MD, MS Professor of Clinical Medicine and Chief, Division of Hospital Medicine University of California, San Diego

    2. Insulin Terminology Basal insulin Long-acting, all Type 1 and most Type 2 DM patients should have basal insulin whether they are eating or not (insulin glargine, insulin detemir, or NPH) Nutritional or pre-meal / prandial insulin Short-acting insulin given with meals in anticipation of carbohydrate load glycemic spike (scheduled insulin aspart, insulin lispro, insulin glulisine, regular insulin) Correction or supplemental insulin Short-acting insulin given to cover high glucose; if substantial use, it should drive adjustment of basal and nutritional insulins

    3. Insulin Terminology Sliding scale insulin This is a dirty word; we don’t use dirty words at UCSD “Mindless medicine,” “paralysis of thought,” “action without benefit,” “insulin insanity” Evidence does not support this technique without basal insulin; unacceptably high rates of Hyperglycemia Hypoglycemia and insulin stacking Iatrogenic DKA in patients with type 1 DM

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