Glucose monitoring for insulin management -
Infection Prevention during Blood Glucose Monitoring and Insulin Administration. Minus Related Pages. On This Page. If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared.
Insulin pens and other medication cartridges and syringes are for single-patient-use only and should never be used for more than one person.
Blood Glucose Monitoring and Insulin Administration. Unsafe Practices during Blood Glucose Monitoring and Insulin Administration. CDC Medscape Commentary. Unsafe practices during assisted monitoring of blood glucose and insulin administration that have contributed to transmission of HBV or have put persons at risk for infection include: Using fingerstick devices for more than one person Using a blood glucose meter for more than one person without cleaning and disinfecting it in between uses Using insulin pens for more than one person Failing to change gloves and perform hand hygiene between fingerstick procedures.
Best Practices for Assisted Blood Glucose Monitoring and Insulin Administration. Fingerstick Devices. Reusable Devices: These devices often resemble a pen and have the means to remove and replace the lancet after each use, allowing the device to be used more than once.
Some of these devices have been previously approved and marketed for multi-patient use, and require the lancet and disposable components platforms or endcaps to be changed between each patient. However, due to failures to change the disposable components, difficulties with cleaning and disinfection after use, and their link to multiple HBV infection outbreaks, CDC recommends that these devices never be used for more than one person.
If these devices are used, it should only be by individual persons using these devices for self-monitoring of blood glucose. Single-use, auto-disabling fingerstick devices: These are devices that are disposable and prevent reuse through an auto-disabling feature.
In settings where assisted monitoring of blood glucose is performed, single-use, auto-disabling fingerstick devices should be used.
Blood Glucose Meters. Blood glucose meters are devices that measure blood glucose levels. Whenever possible, blood glucose meters should be assigned to an individual person and not be shared. A simple rule for safe care: If shared, blood glucose meters should be cleaned and disinfected after every use.
Recommended Practices for Preventing Bloodborne Pathogen Transmission during Blood Glucose Monitoring and Insulin Administration in Healthcare Settings. Fingerstick Devices Restrict use of fingerstick devices to individual persons. They should never be used for more than one person.
Select single-use lancets that permanently retract upon puncture. This adds an extra layer of safety for the patient and the provider. Dispose of used lancets at the point of use in an approved sharps container. Never reuse lancets. Blood Glucose Meters Whenever possible, blood glucose meters should be assigned to an individual person and not be shared.
General Unused supplies and medications should be maintained in clean areas separate from used supplies and equipment e.
Do not carry supplies and medications in pockets. Insulin Administration Insulin pens should be assigned to individual persons and labeled appropriately.
Multiple-dose vials of insulin should be dedicated to a single person whenever possible. If the vial must be used for more than one person it should be stored and prepared in a dedicated medication preparation area outside of the patient care environment and away from potentially contaminated equipment Medication vials should always be entered with a new needle and new syringe Dispose of used injection equipment at point of use in an approved sharps container.
Never reuse needles or syringes. Hand Hygiene Hand washing with soap and water or use of an alcohol-based hand rub Wear gloves during blood glucose monitoring and during any other procedure that involves potential exposure to blood or body fluids.
Change gloves between patient contacts. Change gloves that have touched potentially blood-contaminated objects or fingerstick wounds before touching clean surfaces.
Discard gloves in appropriate receptacles. Perform hand hygiene immediately after removal of gloves and before touching other medical supplies intended for use on other persons. Provide a full hepatitis B vaccination series to all previously unvaccinated staff persons whose activities involve contact with blood or body fluids.
Establish responsibility for oversight of infection control activities. Provide staff members who assume responsibilities for fingersticks and injections with infection control training. Assess adherence to infection control recommendations for blood glucose monitoring and insulin administration by periodically observing staff who perform or assist with these procedures and tracking use of supplies.
Report to public health authorities any suspected instances of a newly acquired bloodborne infection, such as hepatitis B, in a patient, facility resident, or staff member.
Check with state authorities for specific state and federal regulations regarding laboratory testing. Additional Information. CDCs Diabetes and Viral Hepatitis: Important Information on Glucose Monitoring FDA: Information for Healthcare Professionals: Risk of Transmission of Blood-borne Pathogens from Shared Use of Insulin Pens external icon FDA Communication: Guidance for Industry and Food and Drug Administration Staff — Blood Lancet Labeling pdf icon external icon FDA Communication: Letter for Manufacturers of Blood Glucose Monitoring Systems Listed with the FDA [PDF — 39 KB] external icon FDA Communication: Use of Fingerstick Devices on More than One Person Poses Risk for Transmitting Bloodborne Pathogens external icon FDA Patient Safety News: Preventing Bloodborne Infections When Using Fingerstick Device YouTube Video.
J Diabetes Sci Technology ;5 6 : Klonoff DC, Perz JF. J Diabetes Sci Technol ;4 5 Patel AS, White-Comstock MB, Woolard D, Perz JF. Page last reviewed: March 2, Content source: Centers for Disease Control and Prevention , National Center for Emerging and Zoonotic Infectious Diseases NCEZID , Division of Healthcare Quality Promotion DHQP.
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You will be subject to the destination website's privacy policy when you follow the link. In the course of giving an intravenous regular insulin infusion, we recommend starting with approximately half the patient's usual total daily insulin dose, divided into hourly increments until the trend of blood glucose values is known, and then adjusting the dose accordingly.
A reasonable regimen usually involves a continuous insulin infusion at a rate of 1 to 5 units of regular insulin per hour; within this range, the dose of insulin is increased or decreased based on frequently measured glucose concentrations, ideally through the use of an approved protocol.
In patients who are not eating, concomitant glucose infusion is necessary to provide some calories, reduce protein loss, and decrease the risk of hypoglycemia; separate infusions allow for more flexible management. When the patient receiving intravenous insulin is more stable and the intercurrent event has passed, the prior insulin regimen can be resumed, assuming that it was effective in achieving glycemic goals.
Because of the short half-life of intravenous regular insulin , the first dose of subcutaneous insulin must be given before discontinuation of the intravenous insulin infusion.
If intermediate- or long-acting insulin is used, it should be given two to three hours prior to discontinuation, whereas short- or rapid-acting insulin should be given one to two hours prior to stopping the infusion. Patients with type 2 diabetes — The treatment of patients with type 2 diabetes depends upon previous therapy and the prevailing blood glucose concentrations.
Any patient who takes insulin before hospitalization should receive insulin throughout the admission algorithm 1 and algorithm 2 [ 13 ]. If the patient is unable to eat normally, oral agents or injectable GLPbased therapies should be discontinued.
In patients who are eating and who do not have contraindications to their oral agent, oral agents or injectable GLPbased therapies may be cautiously continued if they are on the hospital's formulary see 'Patients treated with oral agents or injectable GLPbased therapies' below.
Therapy should be returned to the patient's previous regimen assuming that it had been effective as soon as possible after the acute episode, usually as soon as the patient has resumed eating his or her usual diet. In those with elevated A1C upon admission, the discharge regimen should be modified to improve glycemic management, or at the very least, the patient should be evaluated by the clinician managing his or her diabetes soon within several weeks after discharge.
Diet-treated patients — Patients with type 2 diabetes treated by diet alone who are to have minor surgery or an imaging procedure, or who have a noncritical acute illness that is expected to be short lived, will typically need no specific antihyperglycemic therapy.
Nevertheless, regular blood glucose monitoring is warranted to identify serious hyperglycemia, especially if steroid therapy is administered. The measurement system used should be standardized to ensure reasonable accuracy and precision. See 'Blood glucose monitoring' above.
Correction insulin with rapid-acting analogs can also be used, but the dosing frequency may need to be every four hours, so the more cost-effective regular insulin is preferred. If substantial doses are required, adding basal insulin will improve glycemia and allow reduced the doses of regular insulin.
Insulin requirements can be estimated based upon a patient's body weight algorithm 1. Alternatively, requirements can be based upon the total number of units of correction insulin administered over the course of a hospital day.
Approximately 50 percent of the total daily dose can be given as basal insulin, and the remaining approximately 50 percent can be given in equally divided doses prior to meals one-third prior to each meal.
Patients treated with oral agents or injectable GLPbased therapies — In general, insulin is the preferred treatment for hyperglycemia in hospitalized patients previously treated with oral agents or injectable glucagon-like peptide 1 [GLP-1]-based therapies.
This approach stems from the fact that insulin doses can be rapidly adjusted and, therefore, can quickly correct worsening hyperglycemia. In addition, noninsulin diabetes therapies have not been widely tested in the hospital setting.
However, there are some circumstances where insulin may not be necessary. As an example, in patients who are well managed on their outpatient regimen, who are eating, and in whom no change in their medical condition or nutritional intake is anticipated, oral agents may be continued, as long as new contraindications are neither present nor anticipated during the hospital admission, and as long as the medications or similar brands are on the hospital formulary.
Of note, injectable GLPbased therapies are expensive and often not on hospital formularies; their use in the hospital setting is therefore uncommon. If a patient was previously eating but is unable to eat after the evening meal in preparation for a procedure the next morning, oral antihyperglycemic drugs should be omitted on the day of a procedure surgical or diagnostic.
If procedures are arranged as early in the day as possible, antihyperglycemic therapy and food intake can simply then be shifted to later in the day.
If the illness requiring admission is more severe eg, an infection requiring hospitalization , hyperglycemia is more likely, even when there is decreased food intake, and most acutely ill patients will need insulin. In this setting, oral agents should be discontinued.
If eating, rapid-acting insulin is preferred, administered before meals. However, a more formal and comprehensive insulin regimen, including some form of basal insulin, is usually preferred when hyperglycemia persists algorithm 1 and algorithm 2.
Oral agents should generally not be administered to patients who are not eating. In addition, many oral agents have specific contraindications that may emerge in hospitalized patients:. Examples include patients with acute cardiac or pulmonary decompensation, acute kidney injury, dehydration, sepsis, urinary obstruction, or in those undergoing surgery or radiocontrast studies.
Given the typical case mix in most acute care hospitals, metformin should probably be discontinued at least temporarily in most patients.
See "Metformin in the treatment of adults with type 2 diabetes mellitus", section on 'Contraindications'. As a result, they have an uncertain role in patients who are not eating.
DPP-4 inhibitors have not been used or studied extensively in the acute care setting [ 23 ]. Two studies suggested that they may be reasonably effective in mildly hyperglycemic patients with type 2 diabetes who are eating [ 23,24 ].
We tend to continue them as they may modestly reduce hyperglycemia and decrease the need for insulin injections. They also have few contraindications or safety concerns, and DPP-4 inhibitors do not increase the risk of hypoglycemia.
All DPP-4 inhibitors except linagliptin require dose reduction in the setting of impaired kidney function. See "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Dosing'.
Although they may be continued during the hospitalization in stable patients who are expected to eat regularly, unexpected alterations in meal intake will increase the risk for hypoglycemia. On balance, sulfonylureas should usually be discontinued, at least temporarily, in the hospitalized patient.
See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'. As a result, these prandial-administered drugs may have a theoretical advantage in hospitalized patients but should also be used cautiously, including in those with acute ischemic heart disease events.
Further limiting their inpatient use, meglitinides are typically not on hospital formularies. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus". As a result, their use should generally be avoided in the acute setting.
They are also not usually included on most hospital formularies, in part due to high cost. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Introduction'.
They increase calorie losses as well as risk of dehydration, volume contraction, and genitourinary tract infections.
In addition, euglycemic diabetic ketoacidosis has been reported in patients with both type 1 during off-label use and, more rarely, type 2 diabetes who were taking SGLT2 inhibitors.
These drugs should therefore generally not be used in the inpatient setting, particularly when patients are acutely ill, although they may be started just prior to discharge if compelling indications are present.
For example, these agents may be used by cardiologists and especially heart failure specialists for the benefit of SGLT2 inhibitors in the setting of heart failure. See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Adverse effects' and "Primary pharmacologic therapy for heart failure with reduced ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors' and "Treatment and prognosis of heart failure with preserved ejection fraction", section on 'Sodium-glucose co-transporter 2 inhibitors'.
If the question of ventricular dysfunction is raised during a hospitalization, thiazolidinediones should be held until the situation is clarified. The antihyperglycemic effect of this drug class extends for several weeks after discontinuation as does the fluid-retaining effect , so that temporary interruption of therapy should have little effect on glycemia.
See "Thiazolidinediones in the treatment of type 2 diabetes mellitus". Moreover, these inhibitors of intestinal carbohydrate absorption are only effective in patients who are eating and therefore have a limited role in this setting.
See "Alpha-glucosidase inhibitors for treatment of diabetes mellitus". Patients treated with insulin — Insulin therapy should be continued in all patients already taking it to maintain a reasonably constant basal level of circulating insulin.
Failing this, severe hyperglycemia or even ketoacidosis can occur, even in patients labeled as having type 2 diabetes but who have become significantly insulin deficient over a prolonged disease course.
If the glucose was well managed with the outpatient insulin regimen, we typically reduce the dose by 25 to 50 percent because, in the more controlled environment of the hospital where the amount of food consumed may be less than at home and blood glucose levels are checked regularly , patients may need considerably less insulin than they were taking in the outpatient setting.
However, clinicians should be ready to rapidly advance the dose if this reduction results in inadequate glycemic management. Different basal-bolus regimens are similarly effective in reducing A1C concentrations when insulin doses are titrated to achieve glycemic goals. In some studies, treatment with such a basal-bolus insulin regimen was associated with better glycemic outcomes than sliding-scale insulin [ ].
As an example, in one open-label, randomized trial of insulin glargine supplemented with preprandial glulisine versus sliding-scale insulin, a greater proportion of patients treated with the basal-bolus regimen achieved target glucose values 66 versus 38 percent, respectively [ 26 ].
However, in this study, the mean daily dose of insulin was more than threefold higher in the basal-bolus-treated patients than in those assigned to sliding scale, likely reflecting a failure to titrate the doses of sliding-scale insulin. Because the high concentration of insulin delays absorption, the pharmacologic profile of U regular insulin is most similar to that of NPH [ 30 ].
Thus, if U is not available, U NPH insulin twice daily should be substituted again, with a 50 percent dose reduction. We would also caution that errors are common with U administration, and clear communication among patient, clinician, nursing staff, and pharmacy is imperative to ensure proper dosing.
Although in the past U insulin was dispensed using standard U insulin or Tuberculin syringes, a dedicated U insulin syringe is available and U insulin should be dispensed with the U insulin syringe, if possible [ 31 ].
The syringe contains scale markings from 25 to units in 5-unit increments total volume 0. The insulin dose should be expressed in units, rather than in volumetric terms as was the convention with the Tuberculin or U syringes.
U insulin syringes are not available with a safety needle and, therefore, may not be allowed in some facilities. In such cases, the U insulin pen device may be used. The pen dosing window shows the number of units of U to be injected, and the pen delivers the volume that corresponds to the selected dose.
If neither dedicated U insulin syringes nor the U insulin pen device is available, U insulin can be dispensed using a Tuberculin syringe, rather than a U insulin syringe, to emphasize that it is different from U regular insulin. With the Tuberculin syringe, every 0.
The obvious concern when using U insulin with a Tuberculin syringe is the potential for confusion of volume and units. For institutions using Tuberculin syringes to deliver U insulin, therefore, U insulin should be dispensed directly from the hospital pharmacy, in individually labelled Tuberculin syringes.
See 'Patients with type 1 diabetes' below. Automated insulin delivery AID systems are typically used in the outpatient setting, more often in patients with type 1 diabetes.
Whether the modest improvement in glycemia in noncritical hospitalized patients improves outcomes and warrants the potential increased cost is uncertain. See "Continuous subcutaneous insulin infusion insulin pump ", section on 'Types of insulin pumps'. If an episode is clearly short lived eg, a procedure done in the early morning , subcutaneous insulin usual dose of short acting and intermediate or long acting and breakfast can simply be delayed until after the episode.
The adjustment of insulin doses in preparation for surgery or other procedures is reviewed in more detail separately. See "Perioperative management of blood glucose in adults with diabetes mellitus", section on 'Insulin injection'.
Once the patient is taking a normal diet, the usual at-home regimen can be restarted, as long as glycemic goals were being met. If altered nutritional intake is present, reduced doses of insulin will be required, starting with doses similar to those administered in the preprocedure setting.
Patients with type 1 diabetes — Patients with type 1 diabetes have an absolute requirement for insulin at all times , whether or not they are eating, to prevent ketosis. The doses of insulin needed are usually lower than in patients with type 2 diabetes since most of the former do not have insulin resistance.
However, their blood glucose concentrations tend to fluctuate more during the course of the illness or procedure. It is important to avoid hypoglycemia, even if the consequence is a temporary modest rise in the blood glucose concentration.
Insulin can be given either subcutaneously or intravenously. Algorithms for glycemic management of nonfasting and fasting patients with type 1 diabetes who are not critically ill are shown for subcutaneous dosing regimens algorithm 1 and algorithm 2 [ 13 ].
If the patient is receiving nothing by mouth, the administration of basal insulin is still required. As examples:. No boluses would be administered until the patient is able to eat. Since nursing staff are not always familiar or comfortable with the use of insulin pumps, patients should be alert enough to manage their pump therapy and possess sufficient vision and dexterity to safely use the device.
In addition, vigilance regarding pump catheter placement is necessary. Catheters may inadvertently be dislodged during transfers in the operating room or in bed, and if the patient is not alert enough to provide self-care, the health care providers should consider changing to conventional injection therapy until the patient is able to manage pump therapy again.
In patients with tightly managed glycemia, an alternative approach is to reduce the dose of glargine by 10 to 20 percent eg, give 16 to 18 units to minimize the risk of hypoglycemia that might require oral ingestion of calories and thereby delay the planned procedure.
Short-acting insulin should not be given, unless significant hyperglycemia is noted, as described above. Blood glucose should be measured every two to three hours until the first meal is eaten. Intravenous glucose at approximately 3. See "Cases illustrating intensive insulin therapy in special situations".
Patients receiving enteral or parenteral feedings — Patients with diabetes who are receiving total parenteral nutrition TPN or tube feeds bolus or continuous require special consideration. TPN — In patients receiving total parenteral nutrition TPN , insulin may be administered as part of the nutritional solution, if allowed by the hospital pharmacy.
To determine the correct dose of insulin to add to the TPN fluid, a separate infusion of regular insulin can be used initially. When glucoses have reached goal, the total daily dose of regular insulin provided by the insulin drip is calculated; 80 percent of this amount is added to the TPN fluid as regular insulin to be delivered over 24 hours.
For example, if the intravenous insulin infusion at steady state was set at 1 unit per hour or 24 units per day , around 80 percent of this amount 20 units should be added to the TPN solution by the pharmacy to be given over the course of the day.
The amount of insulin can then be titrated every one to two days, based upon glucose monitoring. Since more frequent adjustments are impractical and costly, the concurrent use of rapid- or short-acting insulin as correction every six hours will help to fine-tune glycemic management.
See 'Correction insulin' above. If TPN is interrupted, most patients with type 2 diabetes can be followed with careful glucose monitoring. Insulin should be administered if hyperglycemia occurs. In patients with type 1 diabetes, hyperglycemia will occur and can result in ketosis if all insulin is withheld.
Thus, patients with type 1 diabetes require insulin when the TPN is interrupted. The amount and type of insulin depend upon the anticipated duration of the interruption. Because of the potential for inadvertent discontinuation of insulin therapy if TPN is interrupted, some clinicians recommend giving a portion of the basal insulin as an injection eg, 50 percent in patients with type 1 diabetes.
In the example above patient receiving 24 units of regular insulin a day, 80 percent of this amount [19 units] added to the TPN solution , approximately 10 units of regular insulin can be added to the TPN solution and 9 units of NPH, glargine, or detemir administered as a basal injection.
This approach can also be used in insulin-requiring patients with type 2 diabetes. Enteral feedings — In patients receiving continuous enteral feeds, the total daily dose of insulin could be administered as basal insulin alone once-daily glargine, detemir, or degludec, or twice-daily detemir or NPH.
However, if the enteral feeds are unexpectedly discontinued, hypoglycemia may occur. Thus, a safer approach may be to administer approximately 50 percent of the total daily insulin dose as basal insulin and 50 percent as prandial short- or rapid-acting insulin, which is given every four rapid-acting insulin to six short-acting insulin hours [ 33 ].
A similar ratio of basal-to-prandial insulin can be used for patients receiving bolus feeds, for whom the prandial insulin would be divided equally before each bolus feed. Correction rapid- or short-acting insulin can then be administered, as needed, with the prandial insulin same type.
In those receiving cycled enteral feeding eg, 8 to 10 hours overnight , the ideal insulin may be NPH, which has an activity profile similar to this duration, its effect waning when the feeds are stopped. Again, correction rapid- or short-acting insulin can then be administered as needed to optimize glycemic management.
Another approach is to use short-acting insulin alone. This approach is supported by the findings of a randomized trial of sliding-scale, regular insulin every four to six hours alone or in combination with insulin glargine in 50 noncritically ill patients with diabetes receiving enteral nutrition [ 34 ].
There were no differences in any glycemic measures mean study glucose, mean peak or nadir glucose, hypoglycemia events, or total daily insulin dose between the two groups.
However, NPH insulin was required in 48 percent of subjects randomly assigned to sliding-scale, regular insulin. Thus, when sliding-scale, regular insulin alone is chosen as the initial management strategy for patients receiving enteral feeds, the addition of basal insulin is often required to maintain adequate glycemic management.
Consultation — Most of the time, the treatment of hyperglycemia in patients with diabetes in these stressful circumstances can be done by the patient's internist, generalist, or hospitalist. However, each clinician needs to decide whether or not the patient would benefit from additional advice; consultation with a diabetes specialist or endocrinologist may help, particularly if accompanied by a team including personnel who can provide patient education and nutritional advice.
This team approach can decrease the patient's length of stay as well as decrease the total cost of care [ 35,36 ]. Using the hospitalization to enhance the patient's knowledge about the disease and to improve self-management is encouraged. Evaluation of overall care — A brief hospitalization is an excellent opportunity to assess or reassess overall care in patients with diabetes.
If appropriate, attention should be paid to preventive measures such as smoking cessation, hypertension management, treatment of dyslipidemia, and appropriate vaccinations [ 37 ], glycemic management, assessment of possible complications of diabetes, and overall patient education.
This assessment should lead to the formulation of a plan for future treatment after the patient is discharged. See "Overview of general medical care in nonpregnant adults with diabetes mellitus". In type 2 diabetes, an insulin regimen may not be necessary after the illness requiring hospitalization has resolved.
In addition, even when such a regimen is considered to be the ideal outpatient therapy upon discharge, the patient may not be able to comply safely with the prescribed insulin program, which requires a degree of education, commitment, and self-discipline not exhibited by all.
Thus, it is important to determine both the insulin needs as well as the self-care capacities of each patient prior to discharge. Optimal regimens should be individualized for each patient.
Patients may require a significant dose adjustment after discharge from the hospital, which is why clear communication between the clinician dealing with the acute illness and the clinician who will follow the patient's diabetes care after discharge is so important.
Patients found to be newly hyperglycemic during times of illness may actually have undiagnosed diabetes. A glycohemoglobin test A1C can help discriminate between acute, stress-related hyperglycemia and preexistent diabetes.
At a minimum, these individuals should be retested as outpatients upon full recovery. Adequate patient education, discharge planning, and the important transition to the outpatient arena should be facilitated by the personnel dedicated to diabetes care at each institution.
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately.
See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetes mellitus in children". See 'Goals in the hospital setting' above. See 'Noncritically ill' above. More stringent goals may be appropriate for stable patients with previous good glycemic management, and more conservative targets should be set for older patients and those with severe comorbidities where the heightened risk of hypoglycemia may outweigh any potential benefit.
Frequent blood glucose monitoring is warranted to prevent serious hyperglycemia from being unrecognized. See 'Diet-treated patients' above. However, if blood glucose levels are poorly managed with the usual oral agents or if the patient is not eating, drug therapy should be discontinued and insulin initiated algorithm 2.
See 'Patients treated with oral agents or injectable GLPbased therapies' above. See 'Patients treated with insulin' above. For subcutaneous insulin, sliding scales should never be used as the sole insulin. Optimally, basal insulin glargine, detemir, degludec, or neutral protamine hagedorn [NPH] should be combined with prandial and correction insulin typically, rapid-acting insulin algorithm 1 and algorithm 2.
See 'Patients with type 1 diabetes' above. Blood glucose should be measured frequently every one to two hours in patients receiving an insulin infusion. See 'Insulin infusion' above. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in.
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