PRESCRIBING INSULIN ON ADMISSION

• If patient is not eating and drinking, escalate to a senior clinician
• Confirm that patient is on insulin

Type (brand), dose and frequency of insulin

• Search for patient’s type (brand), dose and frequency of insulin. Search sources of information

• If taking, prescribe patient’s oral diabetic medication

Insulin type and dose known

• Prescribe insulin(s) by brand, and the number of units and frequency on the regular section of the medication chart

Insulin type known, dose unknown

• Establish patient’s frequency of insulin. Search sources of information

Prescribe insulin according to body weight at 0.3 units/kg/day

• If patient was administering insulin:
• once daily: prescribe their usual insulin (by brand) once daily
• twice daily: prescribe their usual insulin (by brand) – give 2/3 of the total dose in the morning and 1/3 in the evening (at tea/dinnertime)
• If patient was administering a basal-bolus regimen prescribe their usual insulin (by brand):
• give 1/3 of the total dose using long-acting insulin at 2200 hr
• split remaining 2/3 of total dose into 3 equal doses of short-acting insulin for breakfast, lunch and tea/dinner
• see Example

Both insulin type and dose unknown - Type 1 diabetes

• Establish patient’s frequency of insulin. Search sources of information

Prescribe insulin according to body weight at 0.3 units/kg/day

• If patient was administering insulin:
• twice daily: prescribe Novomix 30, give 2/3 of total dose in the morning and 1/3 in the evening (at tea/dinnertime)
• three/four times a day: prescribe a basal/bolus combination – give 1/3 of the total dose as Lantus (insulin glargine) at 2200 hr. Split remaining 2/3 of total dose into 3 equal doses of short acting insulin (e.g. Novorapid) for breakfast, lunch and tea/dinner
• see Example

Both insulin type and dose unknown - Type 2 diabetes

• Prescribe patients regular oral diabetic medication
• If on insulin pre-admission: prescribe Lantus (insulin glargine) according to body weight at 0.3 units/kg/day
• Seek advice from diabetes or pharmacy team

Monitor

• Capillary blood glucose 4-hrly and titrate Insulin dose accordingly