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IP – Diabetes – Insulin Transition – IV to Subcutaneous – Adult - Supplemental

IP – Diabetes – Insulin Transition – IV to Subcutaneous – Adult - Supplemental - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Diabetes - Insulin Transition - IV to Subcutaneous - Adult - Supplemental [5254]
Intended for Adult Patients Only
If patient meets the following criteria DO NOT use this order set, instead consult Diabetes Management Service:
1) Critically ill patient requiring vasopressors
2) Acute MI with cardiogenic shock
3) Blood glucose persistently > 180 mg/dL
4) Unresolved diabetic ketoacidosis (DKA)
5) Acute changes in renal function (serum creatinine increase of 0.3 mg/dL over the last 48 hours)
6) Patients receiving acute high-dose steroids (> 40 mg prednisone or equivalent daily) or undergoing a high-dose steroid
taper
7) Receiving total parenteral nutrition.
8) If Total Daily Dose is > 120 units/day or > 1 unit/kg/day
- Patient should receive scheduled insulin if: 1) Type 1 diabetes; 2) Type 2 insulin-requiring diabetes; 3) Mean insulin
infusion rate of >1 unit/hr.
- Patients may not require scheduled insulin if no history of insulin requirement and mean infusion rate of < 1 unit/hr.
Total Daily Dose Calculation
NOTE: Patients with A1c < 8% may use previous home insulin dosing.
1. Calculate average rate (units/hour) of insulin infusion over the previous 8 hours.
2. Average rate (units/hour) X 24 = Total average daily dose.
3. Total average daily dose X 0.8 = Total daily dose.
Scheduled Insulin- Minimal Nutrition (NPO, eating/receiving <= 50% of meals or goal tube
feed, or on clear liquid diet)
Basal Insulin (Single Response) [143271]
Give 100% of Total Daily Dose PRIOR to discontinuation of IV insulin.
Basal Insulin - Minimal Nutrition [143654]
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See Note
order for administration timing.
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, 1 X DAILY
Administer even if NPO. Do not mix with other insulins.
Correction Insulin - Daytime or Every Six Hours - LISPRO (Single Response) [20045]
insulin lispro (human) 100 units/mL injection - DAYTIME
- 1-5 Units [760321]
1-5 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
insulin lispro (human) 100 units/mL injection - EVERY
SIX HOURS - 1-5 UNITS [760321]
1-5 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Admin Instructions
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped
insulin lispro (human) 100 units/mL injection - DAYTIME
- 2-10 units [760321]
2-10 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
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Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
insulin lispro (human) 100 units/mL injection - EVERY
SIX HOURS - 2-10 Units [760321]
2-10 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped
Correction Insulin - Bedtime - LISPRO (Single Response) [20046]
insulin lispro (human) 100 units/mL injection - BEDTIME
1-4 Units [760321]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units;
For blood glucose 251-300 mg/dL give 2 units;
For blood glucose 301-350 mg/dL give 3 units;
For blood glucose 351-400 mg/dL give 4 units;
Give even if NPO
insulin lispro (human) 100 units/mL injection - BEDTIME
2-8 units [760321]
2-8 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 4 units;
For blood glucose 301-350 mg/dL give 6 units;
For blood glucose 351-400 mg/dL give 8 units;
Give even if NPO
Correction Insulin - Daytime or Every Six Hours - REGULAR (Single Response) [20042]
insulin regular (human) 100 units/mL injection -
DAYTIME - 1-5 Units [45422]
1-5 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 6 hours when NPO
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 1-5 Units [45422]
1-5 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped
insulin regular (human) 100 units/mL injection -
DAYTIME - 2-10 Units [45422]
2-10 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 6 hours when NPO
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 2-10 Units [45422]
2-10 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 2 unit;
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped
Correction Insulin - Bedtime - REGULAR (Single Response) [20044]
insulin regular (human) 100 units/mL injection -
BEDTIME - 1-4 units [45422]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units
For blood glucose 251-300 mg/dL give 2 units
For blood glucose 301-350 mg/dL give 3 units
For blood glucose 351-400 mg/dL give 4 units
insulin regular (human) 100 units/mL injection -
BEDTIME - 2-8 units [45422]
2-8 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 2 units
For blood glucose 251-300 mg/dL give 4 units
For blood glucose 301-350 mg/dL give 6 units
For blood glucose 351-400 mg/dL give 8 units
Scheduled Insulin- Full Nutrition- NO Tube Feeding (Eating > 50% of meals)
Basal Insulin (Single Response) [143274]
Give 40-50% of Total Daily Dose PRIOR to discontinuation of IV insulin.
Basal Insulin - Full Nutrition NO Tube Feeding [143654]
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See Note
order for administration timing.
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, 1 X DAILY
Administer even if NPO. Do not mix with other insulins.
Nutritional Insulin [143276]
Give 50-60% of Total Daily Dose divided across 3 meals.
insulin lispro (human) 100 units/mL injection -
BREAKFAST [760321]
Subcutaneous, 1 X DAILY
Give within 15 minutes of breakfast
insulin lispro (human) 100 units/mL injection - LUNCH
[760321]
Subcutaneous, 1 X DAILY (NOON)
Give within 15 minutes of lunch
insulin lispro (human) 100 units/mL injection - DINNER
[760321]
Subcutaneous, 1 X DAILY (PM)
Give within 15 minutes of dinner
Correction Insulin - Daytime - LISPRO (Single Response) [144488]
insulin lispro (human) 100 units/mL injection - DAYTIME
- 1-5 Units [760321]
1-5 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
insulin lispro (human) 100 units/mL injection - DAYTIME
- 2-10 units [760321]
2-10 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
Correction Insulin - Bedtime - LISPRO (Single Response) [20046]
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Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


insulin lispro (human) 100 units/mL injection - BEDTIME
1-4 Units [760321]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units;
For blood glucose 251-300 mg/dL give 2 units;
For blood glucose 301-350 mg/dL give 3 units;
For blood glucose 351-400 mg/dL give 4 units;
Give even if NPO
insulin lispro (human) 100 units/mL injection - BEDTIME
2-8 units [760321]
2-8 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 4 units;
For blood glucose 301-350 mg/dL give 6 units;
For blood glucose 351-400 mg/dL give 8 units;
Give even if NPO
Scheduled Insulin- Full Nutrition- WITH Tube Feeding (Receiving > 50% of goal tube
feeds)
Basal Insulin (Single Response) [143278]
Give 30-40% of Total Daily Dose PRIOR to discontinuation of IV insulin (Patients with Type 1 or insulin-requiring Type 2
diabetes).
Patients with no history of diabetes or use of medications or insulin for diabetes may NOT require basal insulin.
Basal Insulin - Full Nutrition WITH Tube Feeding
[143654]
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See Note
order for administration timing.
insulin glargine (LANTUS) 100 units/mL injection
[760291]
Subcutaneous, 1 X DAILY
Administer even if NPO. Do not mix with other insulins.
Nutritional Insulin [143279]
Give 60-70% of Total Daily Dose divided across 4 doses (Patients with Type 1 or insulin-requiring Type 2 diabetes).
Give 100% of Total Daily Dose divided across 4 doses (Patients with no history of diabetes or use of medications or
insulin for diabetes).
insulin regular (human) 100 units/mL vial (MULTIDOSE)
[45422]
Subcutaneous, EVERY 6 HOURS
Give prior to discontinuation of IV insulin infusion, if insulin
glargine not administered. Give dose with tube feeding. Hold
dose if tube feeds are on hold. See Note order for
administration timing.
Correction Insulin - Every Six Hours - REGULAR (Single Response) [144490]
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 1-5 Units [45422]
1-5 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 2-10 Units [45422]
2-10 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped
NO Scheduled Insulin - Minimal Nutrition (NPO) OR Full Nutrition WITH Tube Feeding
Correction Insulin - Every Six Hours - LISPRO (Single Response) [144491]
insulin lispro (HUMALOG) 100 units/mL injection -
EVERY SIX HOURS - 1-5 UNITS [760321]
1-5 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Admin Instructions
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Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


For blood glucose 151-200 mg/dL give 1 unit; For blood
glucose 201-250 mg/dL give 2 units; For blood glucose 251-
300 mg/dL give 3 units; For blood glucose 301-350 mg/dL
give 4 units; For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped
insulin lispro (HUMALOG) 100 units/mL injection -
EVERY 6 HOURS - 2-10 Units [760321]
2-10 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 2 unit; For blood
glucose 201-250 mg/dL give 4 units; For blood glucose 251-
300 mg/dL give 6 units; For blood glucose 301-350 mg/dL
give 8 units; For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped
Correction Insulin - Every Six Hours - REGULAR (Single Response) [144490]
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 1-5 Units [45422]
1-5 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped
insulin regular (human) 100 units/mL injection - EVERY
SIX HOURS - 2-10 Units [45422]
2-10 units, Subcutaneous, EVERY 6 HOURS PRN,
hyperglycemia - See Administration Instructions
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped
NO Scheduled Insulin - Full Nutrition - NO Tube Feeding
Correction Insulin - Daytime - LISPRO (Single Response) [144488]
insulin lispro (human) 100 units/mL injection - DAYTIME
- 1-5 Units [760321]
1-5 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 1 unit;
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 3 units;
For blood glucose 301-350 mg/dL give 4 units;
For blood glucose 351-400 mg/dL give 5 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
insulin lispro (human) 100 units/mL injection - DAYTIME
- 2-10 units [760321]
2-10 units, Subcutaneous, 3 X DAILY PRN, daytime
hyperglycemia - See Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 unit;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give more often
than every 4 hours when NPO
Correction Insulin - Bedtime - LISPRO (Single Response) [20046]
insulin lispro (human) 100 units/mL injection - BEDTIME
1-4 Units [760321]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units;
For blood glucose 251-300 mg/dL give 2 units;
For blood glucose 301-350 mg/dL give 3 units;
For blood glucose 351-400 mg/dL give 4 units;
Page 5 of 7
Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Give even if NPO
insulin lispro (human) 100 units/mL injection - BEDTIME
2-8 units [760321]
2-8 units, Subcutaneous, 1 X DAILY (HS) PRN,
hyperglycemia - See Administration Instructions
For blood glucose 201-250 mg/dL give 2 units;
For blood glucose 251-300 mg/dL give 4 units;
For blood glucose 301-350 mg/dL give 6 units;
For blood glucose 351-400 mg/dL give 8 units;
Give even if NPO
Patient Care Orders
Non-categorized [145103]
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today, Routine
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] EVERY 6 HRS IF NPO/ CONT. TUBE FEEDING/ OR TPN,
Starting today, Routine
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] CONDITIONAL - RN COLLECT, Starting today, Routine
If Conditional, What Condition? 30 minutes before start of
cyclic tube feeding and 6 hours after initiation
Glucose, POC [IPGLUCOSE] SUPPLEMENTAL CHECK AT 0200, Starting today, Routine
If Conditional, What Condition?
Contingency Parameters [145105]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Laboratory
Conditional Labs [145106]
GLUCOSE [GLU] CONDITIONAL - RN COLLECT, Starting today, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose less
than 40 or greater than 400 mg/dL
Draw if blood glucose less than 40 or greater than 400 mg/dL
IV Insulin Discontinuation
IV Insulin Discontinuation [143284]
Select the insulin combination ordered above.
Note: Discontinue IV Insulin (see Admin. Inst.) [950018] ONCE Starting today For 1 Doses
If glargine insulin alone is given, discontinue the IV insulin
infusion 4 hours after administration of glargine insulin.
If lispro and glargine insulin are given together, discontinue
the IV insulin infusion 15 minutes after administration of lispro
insulin.
If regular and glargine insulin are given together, discontinue
the IV insulin infusion 30 minutes after administration of
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Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


regular insulin.
If regular insulin alone is given, discontinue the IV insulin
infusion 30 minutes after administration of regular insulin.
If no scheduled subcutaneous insulin is ordered for transition
off of the IV insulin infusion, stop the IV insulin infusion now.
Consults
Consults [143266]
Consult Diabetes Management Service (Inpatient)
[CON0022]
ONCE, Starting today
New diagnosis of diabetes (any type):
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education (Adult)
[CON0021]
ONCE, Starting today For 1 Occurrences, Routine
Type of Education: Diabetes Self-Management Education
New diagnosis of diabetes (any type):
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Starting today For 1 Occurrences, Routine
Type of Education: Diabetes Self-Management Education
Reason for Consult:
Page 7 of 7
Pr i nt ed by SPENCER, LINDSEY M [LMS033] at 1/14/2014 8:23:19 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority