Essential Facts on the Go: Internal Medicine (24 page)

Prepare for SQ insulin once

– AG is closed × 2

– FS < 250

How much insulin did the patient receive in the past 6 hours?

– (Amount × 4) × 80% = total daily insulin need

– Total daily insulin need

50% basal (long acting)

50% pre-meal (short acting)

Ex: insulin GTT @ 5 units/hr for last 6 hrs

– 5 × 4 = 20 unit × 80% = 16 units

  – 50% basal = 8 units of long-acting insulin now

  – 50% pre-meal = ~ 3 units of short-acting insulin pre-meal

Keep insulin GTT on × 2 hrs after giving long-acting basal insulin to prevent hyperglycemia

Management of Electrolyte Abnormalities

Potassium/hypokalemia

Monitor K+ levels every 3 hours

Insulin will cause K+ to shift intracellularly

Keep serum K+ between 4-5 mEq/L

If K+ < 4 prior to initiating insulin therapy

Severe total body K+ depletion