/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/diabetes-and-endocrinology/,/clinical/cckm-tools/content/cpg/diabetes-and-endocrinology/related/,

/clinical/cckm-tools/content/cpg/diabetes-and-endocrinology/related/name-97509-en.cckm

201705121

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Diabetes and Endocrinology,Related

Diabetes Medication Adjustment (Inpatient Procedures)

Diabetes Medication Adjustment (Inpatient Procedures) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Diabetes and Endocrinology, Related


Last Updated 3/23/2017 | Last Reviewed 2/23/2017
Questions? Contact Inpatient Diabetes Quality Committee


 Patients with type 1 DM & insulin-requiring type 2 DM must have some basal (long-acting) insulin even when NPO.




Type of Insulin Onset Peak Duration Adjustment When NPO A written/verbal order is needed to adjust insulin.
B
ol
us

In
su
li
n Humalog (lispro)
Novolog (aspart)
Apidra (glulisine)
Humalog U-200

5-15”

1-2 hours 4-6 hours

 Hold scheduled dose
 Give correction insulin as ordered to cover elevated glucoses (i.e. >150 mg/dL)
Regular 30-60” 2-4 hours 6-10 hours
B
as
a
l
In
su
li
n
NPH 1-2 hours 4-8 hours 10-20 hours  Take ½ of AM dose (Give entire PM or HS dose)
**If NPH is being given to cover prednisone, the full dose may be needed.
Detemir (Levemir ) 1-2 hours 8-12 hours 12-24 hours  Give usual dose. Use caution for those who use basal insulin ONLY without oral agents
or insulin for meal coverage. These patients may need 20-50% less than usual dose.
 Given long duration of action for degludec, convert to alternative basal insulin while
hospitalized.
Degludec
(Tresiba U-100) 1 hour 12 hours 42+ hours
Glargine
(Lantus /Basaglar ) 1-2 hours Flat ~24 hours
Co
m
bi
na
ti
on
s
Insulin combinations containing mixtures of intermediate-acting
and short-acting or rapid-acting insulins will have onset, peak
and duration of action similar to the individual components.
 Combination insulins should not be used when NPO since the short-acting or rapid-
acting component of the combination will cause hypoglycemia.
 Orders for NPH and Regular (or rapid-acting) should be obtained. Give ½ dose of NPH
and hold Regular (or rapid-acting). (Example: 30 units of 70/30 = 21 units NPH and 9
units Regular. Give 10 units NPH; hold Regular.)
Co
n
ce
nt
ra
te
d
Degludec U-200 (Tresiba® U-200): duration of action – 42 hours
Glargine U-300 (Toujeo®): duration of action – 36 hours
U-500: duration of action – 12 hours
 NPO adjustment for concentrated insulin types vary. Diabetes/endocrine specialists
should be consulted to determine adjustment.
 Given long duration of action for degludec U-200 and glargine U-300, convert to
alternative basal insulin while hospitalized.
Oral Agents and Non-Insulin Injectables  Hold all oral agents and non-insulin injectables(Orders are required)
Medication Class/ Examples
Biguanides (metformin): consider re-checking SCr post-procedure if patient has received contrast AND has history of renal disease.
Sulfonylureas (glipizide, glyburide, glimepiride)
Meglitinides (repaglinide, nateglinide)
Thiazolidinediones (“TZDs” – i.e., pioglitazone, rosiglitazone)
DPP-4 inhibitors (“gliptins” – i.e., sitagliptin, saxagliptin, linagliptin, alogliptin)
GLP-1 agonists (i.e., exenatide, liraglutide, albiglutide, dulaglutide)
SGLT-2 Inhibitors (“flozins” – i.e., canagliflozin, dapagliflozin, empagliflozin)
Medication Adjustment for Hospitalized Patients who are NPO
Association AD. Professional Practice
Committee for the Standards of Medical Care
in Diabetes-2017. Diabetes Care. Jan 2017;40
Suppl 1:S1-135.