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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98192-en.cckm

201706160

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UWHC,UWMF,

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ED/IP – Diabetes – Insulin Transition – IV to Subcutaneous – Adult – Supplemental [5254]

ED/IP – Diabetes – Insulin Transition – IV to Subcutaneous – Adult – Supplemental [5254] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


ED/IP - Diabetes - Insulin Transition - IV to Subcutaneous - Adult - Supplemental
[5254]
DO NOT use this order set if patient meets any of the following criteria, 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) or hyperglycemic hyperosmolar state
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) Receiving tube feeding and not at goal
9) 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.
For Total Daily Dose (TDD) Calculation, refer to Insulin Transition Algorithm (Step 4)
TDD (units/day) = average insulin infusion rate over previous 8 hours (units/hour) X 24
hours X conversion safety factor (0.8)
Determine current nutrition status- Choose group below.
- Minimal Nutrition: Patient is NPO, eating <= 50% of meals or is on a clear liquid diet.
- Full Nutrition: Patient is eating > 50% of meals or is receiving > 50% of continuous goal
tube feeds.
Refer to IV to Subcutaneous Insulin Transition Algorithm (link below)
IV to Subcutaneous Insulin Transition Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97514-en.cckm
Patient Care Orders
Non-Categorized Patient Care Orders [191756]
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] EVERY 6 HRS IF NPO/ CONT. TUBE FEEDING/ OR
TPN, Starting today, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Page 1 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2017CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] CONDITIONAL - RN COLLECT, Starting today,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
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, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
IV Insulin Discontinuation
IV Insulin Discontinuation [143284]
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 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.
Medications - Minimal Nutrition
Basal Insulin (Single Response) [143271]
insulin.100% of Total Daily Dose PRIOR to discontinuation of IV Give
Basal Insulin - Minimal Nutrition [143654]
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See
Note order for administration timing.
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
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) (HUMALOG) 100 UNIT/ML
injection - DAYTIME 1-5 units [53264]
1-5 units, Subcutaneous, 3 X DAILY (AT MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
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.
Page 2 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - EVERY 6 HOURS 1-5 units [53264]
1-5 units, Subcutaneous, EVERY 6 HOURS
For hyperglycemia ONLY
For blood glucose < 151 mg/dL give no additional
units;
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) (HUMALOG) 100 UNIT/ML
injection - DAYTIME 2-10 units [53264]
2-10 units, Subcutaneous, 3 X DAILY (AT
MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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.
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - EVERY 6 hours 2-10 units [53264]
2-10 units, Subcutaneous, EVERY 6 HOURS
For hyperglycemia ONLY
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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) (HUMALOG) 100 UNIT/ML
injection - BEDTIME 1-4 units [53264]
1-4 units, Subcutaneous, 1 X DAILY (HS)
For bedtime hyperglycemia ONLY
For blood glucose units;
For blood glucose 201-250 mg/dL give 1 unit;
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) (HUMALOG) 100 UNIT/ML
injection - BEDTIME 2-8 units [53264]
2-8 units, Subcutaneous, 1 X DAILY (HS)
For bedtime hyperglycemia ONLY
For blood glucose units;
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]
Page 3 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin regular (human) 100 units/mL injection -
DAYTIME - 1-5 Units [45422]
1-5 units, Subcutaneous, 3 X DAILY (AT MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
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
For hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
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 (AT
MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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
For hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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)
For bedtime hyperglycemia ONLY.
For blood glucose <= 200 mg/dL give no additional
units;
For blood glucose 201-250 mg/dL give 1 unit;
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 4 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin regular (human) 100 units/mL injection -
BEDTIME - 2-8 units [45422]
2-8 units, Subcutaneous, 1 X DAILY (HS)
For bedtime hyperglycemia ONLY.
For blood glucose <= 200 mg/dL give no additional
units;
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.
Medications - Full Nutrition- NO Tube Feeding
Basal Insulin (Single Response) [143274]
insulin.50% of Total Daily Dose PRIOR to discontinuation of IV -40Give
Basal Insulin - Full Nutrition NO Tube Feeding
[143654]
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See
Note order for administration timing.
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, 1 X DAILY
Administer even if NPO. Do not mix with other
insulins.
Nutritional Insulin (Single Response) [143277]
Insulin Lispro with Insulin to Carbohydrate Ratio
(Carb Counting) [129171]
Select Insulin to Carbohydrate Ratio (ICR)
STEP 1: Calculate the patient’s Total Daily Dose
STEP 2: Select corresponding ICR. (Enter Admin Instructions below)
STEP 3: Adjust ICR if glucoses remain >180 mg/dL.
Other Considerations:
• A custom ICR may be entered for pts with established regimen at home.
• RENAL INSUFFICIENCY/FAILURE: select a higher ratio to decrease hypoglycemia risk (e.g.,
if patient’s TDD is 40 units increase the ICR from 1:12 to 1:15
• BASAL INSULIN ONLY PTA (dose >/=40 units/day): select corresponding ICR using chart
above; then reduce basal dose by 25-50%.
Insulin to Carbohydrate Ratios- Adult (ICRs) URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97513-en.cckm
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
0-30, Subcutaneous, 3 X DAILY (AT MEALTIME)
Insulin to Carbohydrate Ratio (ICR) {RXR INSULIN
TO CARBOHYDRATE RATIO (ICR):2000496}
Document carbohydrate grams eaten in Doc
Flowsheet.
Measure Carbohydrate Intake [NURDIE0016] CONTINUOUS, Routine, Document carbohydrate
grams eaten in Doc Flowsheet
Total Daily Dose (TDD)
(total amount of scheduled basal
and nutritional insulin doses in 24
hours)
Insulin to Carbohydrate Ratio
(ICR) (1 unit insulin covers ____
grams of carbohydrate)
15 - 29 units 1 unit:20 grams
30 – 39 units 1 unit:15 grams
40 – 49 units 1 unit:12 grams
50 – 59 units 1 unit:10 grams
60 - 89 units 1 unit:8 grams
90-119 units 1 unit:5 grams
> 120 units 1 unit: 4 grams
Page 5 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin lispro - Note: Snack carbohydrate
counting dose [53264]
0-30, Subcutaneous, PRN, For snacks > 30 g
Insulin to Carbohydrate Ratio (ICR) {RXR INSULIN
TO CARBOHYDRATE RATIO (ICR):2000496}
Document carbohydrate grams eaten in Doc
Flowsheet
Insulin Lispro with Provider Determined Dosing
[145586]
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - BREAKFAST [53264]
Subcutaneous, 1 X DAILY
Hold dose if patient NPO. Give half dose if patient
eating < 50% of meal. Give within 15 minutes of
breakfast
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - LUNCH [53264]
Subcutaneous, 1 X DAILY (NOON)
Hold dose if patient NPO. Give half dose if patient
eating < 50% of meal. Give within 15 minutes of
lunch
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - DINNER [53264]
Subcutaneous, 1 X DAILY (PM)
Hold dose if patient NPO. Give half dose if patient
eating < 50% of meal. Give within 15 minutes of
dinner
Insulin Lispro with Patient Controlled Dosing
[129169]
Measure Carbohydrate Intake [NURDIE0016] CONTINUOUS, Routine, Document carbohydrate
grams eaten in Doc Flowsheet
insulin lispro (human) 100 UNIT/ML injection -
Patient Controlled Dose [53264]
0-30, Subcutaneous, 3 X DAILY (AT MEALTIME)
Patient determined dose of insulin lispro given
subcutaneously with meals using ***
Document carbohydrate grams eaten in Doc
Flowsheet
Correction Insulin - Daytime - LISPRO (Single Response) [144488]
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - DAYTIME 1-5 units [53264]
1-5 units, Subcutaneous, 3 X DAILY (AT MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
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) (HUMALOG) 100 UNIT/ML
injection - DAYTIME 2-10 units [53264]
2-10 units, Subcutaneous, 3 X DAILY (AT
MEALTIME)
For daytime hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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]
Page 6 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection - BEDTIME 1-4 units [53264]
1-4 units, Subcutaneous, 1 X DAILY (HS)
For bedtime hyperglycemia ONLY
For blood glucose units;
For blood glucose 201-250 mg/dL give 1 unit;
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) (HUMALOG) 100 UNIT/ML
injection - BEDTIME 2-8 units [53264]
2-8 units, Subcutaneous, 1 X DAILY (HS)
For bedtime hyperglycemia ONLY
For blood glucose units;
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.
Medications - Full Nutrition- WITH Tube Feeding
Basal Insulin (Single Response) [143278]
(Patients with Type 1 or 40% of Total Daily Dose PRIOR to discontinuation of IV insulin -30Give
diabetes). requiring Type 2 -insulin
may NOT with no history of diabetes or use of medications or insulin for diabetes Patients
require basal insulin.
Basal Insulin - Full Nutrition WITH Tube Feeding
[143654]
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, ONCE For 1 Doses
Administer PRIOR to IV insulin discontinuation. See
Note order for administration timing.
insulin glargine (LANTUS) 100 UNIT/ML injection
[64829]
Subcutaneous, 1 X DAILY
Administer even if NPO. Do not mix with other
insulins
Nutritional Insulin [143279]
-insulin70% of Total Daily Dose divided across 4 doses (Patients with Type 1 or -60Give
requiring Type 2 diabetes).
of diabetes or 100% of Total Daily Dose divided across 4 doses (Patients with no history Give
diabetes).use of medications or insulin for
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.
Notify provider if tube feeding stopped
[NURCOM0022]
CONTINUOUS, Notify provider immediately if tube
feeding is stopped unexpectedly (due to clogged tube
or for upcoming procedure/surgery) to place orders
for increased glucose monitoring and/or adjust insulin
or IV fluid order to avoid severe hypoglycemia from
active insulin.
Correction Insulin - Every Six Hours - REGULAR (Single Response) [144490]
Page 7 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

insulin regular (human) 100 units/mL injection -
EVERY SIX HOURS - 1-5 Units [45422]
1-5 units, Subcutaneous, EVERY 6 HOURS
For hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
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
For hyperglycemia ONLY.
For blood glucose < 151 mg/dL give no additional
units;
For blood glucose 151-200 mg/dL give 2 units;
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.
Medications - Hypoglycemia Treatment
Hypoglycemia Management [123771]
URL:
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until
specified, Routine, Glucose, POC should always be
ordered in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
Routine, Glucose, POC should always be ordered
in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less
than 40 mg/dL), recheck glucose after 1 hour to
ensure glucose remains greater than or equal to
70mg/dL. After resolution of mild hypoglycemia
(i.e., glucose 40-69 mg/dL), consider rechecking
after 1 hour if patient has signs/symptoms of
hypoglycemia or is at risk for a subsequent
hypoglycemic event (e.g., previously administered
insulin still active, altered renal status, altered
mental status, NPO or interrupted nutrition, or any
other condition that increases hypoglycemia risk)
Page 8 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose
less than 40mg/dL and patient able to eat/swallow
safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
40-69 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but
unable to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely
AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less
than 40 mg/dL and patient unable to eat/swallow
safely AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia
Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For
7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Page 9 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 6/16/17
For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Consults
Consults [104225]
Diabetes Consult Order Panel (Adult) [188497]
Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes education
(meter/insulin skills/other diabetes survival skills) for patients/families with knowledge deficits
and/or need for diabetes knowledge assessment. Recommended for all new diagnoses or
patients with A1C > 9.
Diabetes Education – Nutrition: Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available
on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on
holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Page 10 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly
diagnosed and/or is new to insulin therapy, provide
24 hours notice to allow adequate time for nutrition
education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for
a patient who will be discharging that weekend,
please have the Paging Center contact the on-call
dietitian to help you facilitate the diabetes nutrition
education session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Page 11 of 11
Printed by SPENCER, LINDSEY M [LMS033] at 6/8/2017 5:48:07 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org