Adequate correction of substantial hyperglycaemia in patients with insulin-treated diabetes using a novel algorithm

---

H.M. de Wit, E.E. Engwerda, B.E. de Galan, C.J. Tack

Voorzitter(s): prof. dr. M.M.E. Schneider, UMCU, Utrecht & dr. L.J.M. de Heide, Zorgroep Noorderbreedt, Leeuwarden

Woensdag 22 april 2015

15:00 - 16:00u in Zaal 0.4

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 3: Case reports/research

---

Background:
Correction of substantial hyperglycaemia in patients with diabetes is often difficult because of hyperglycaemia-induced glucose toxicity leading to peripheral insulin resistance. Usually, standard sliding scale regimens, barely adjusted to individual needs, are applied both in the outpatient and in-patient setting. We tested a simple formula based on the insulin sensitivity factor to estimate the insulin dose needed to correct substantial hyperglycaemia in individual diabetic patients.

Methods:
This analysis was part of a randomized controlled cross-over trial conducted in insulin-treated patients with diabetes, comparing the efficacy of two insulin pens for the administration of rapid-acting insulin to correct spontaneous hyperglycaemia (18-23 mmol/l). The dose of rapid-acting insulin to be injected was calculated as follows: ([measured glucose-value in mmol/l - 6] ÷ [100÷total daily insulin dose]) - 1.5. Plasma glucose levels were measured for 6 hours after insulin administration.

Results:
20 patients (10 type 1 diabetes, 10 type 2 diabetes, mean age 53.4 years, HbA1c 8.6%, TDID 96.1 U/day) underwent 40 experiments. Glucose values dropped from 21.3±0.4 to 7.3±0.4 mmol/l after injection of 21.7±1.9 insulin units. After 196.2±11.7 minutes, plasma glucose levels dropped below 10 mmol/l. The formula predicted well on 27 occasions (67.5%), slightly under-predicted insulin needs on 6 (15%) occasions (glucose nadir at 12.3±0.5 mmol/l) and over-predicted on 7 (17.5%) occasions (glucose

Conclusion:
We developed an easy-to-use formula to calculate individualized insulin correction doses. Using this formula substantial hyperglycaemia could be corrected in ~3 hours in the majority of diabetic patients.