Insulin & Glycemic Targets

• Target 140–180 mg/dL (7.8–10 mmol/L); tight control (80–110) increases hypoglycemia and mortality.
• Protocolized IV insulin infusion in the critically ill; capillary glucose q1h until stable.
• For hypoglycemia <70, give 20–25 g IV dextrose and recheck in 15 min.
• Switch to SC basal-bolus once eating/stable.
• Continue IV insulin until DKA has resolved; start the basal-insulin overlap 1–2 hours before stopping the infusion.

Adjusting the Insulin Infusion

• STEP 1 — Check the current blood glucose (BG) and the hourly rate of change
• BG <70 mg/dL?
• Manage as hypoglycemia: 20–25 g IV dextrose, recheck in 15 min, then adjust the infusion per protocol
• Titrate the IV insulin infusion per the locally validated protocol, targeting 140–180 mg/dL; check BG q1h until stable
• In DKA never reduce the insulin infusion below 1 U/h; start SC basal insulin with a 1–2 h overlap before stopping the infusion
• BG stable in target on a low infusion rate, and the patient eating?
• Transition to SC basal-bolus insulin with a 1–2 h overlap before discontinuing the infusion
• Continue the infusion; reassess hourly
• Table-driven protocols (e.g., the Yale regimen) vary between institutions — follow the locally validated version