What is the frequency for administering insulin for hyperglycemia with a glucose level of 516?

Management of Severe Hyperglycemia (Glucose 516 mg/dL)

For a glucose level of 516 mg/dL, immediate insulin administration is required, with point-of-care glucose monitoring every 1-2 hours until glucose levels stabilize below 180 mg/dL, then every 4-6 hours thereafter. 1

Initial Management Algorithm

1. Immediate intervention required:

   • For non-critically ill patients: Administer subcutaneous insulin using a basal-bolus-correction approach
   • For critically ill patients: Consider intravenous insulin infusion with monitoring every 30 minutes to 2 hours

2. Insulin dosing strategy:

   • Correction dose: Administer rapid-acting insulin immediately to address severe hyperglycemia
   • Basal insulin: Initiate or adjust basal insulin to provide 24-hour background coverage
   • Follow-up dose: Schedule next insulin dose based on nutritional status:
     • If eating: Before next meal (typically 4-6 hours)
     • If NPO or continuous feeding: Every 4-6 hours

Monitoring Protocol

• Initial phase (glucose >250 mg/dL): Check glucose every 1-2 hours
• After stabilization (<180 mg/dL):
  • Eating patients: Before meals
  • NPO patients: Every 4-6 hours 1
• For IV insulin: Every 30 minutes to 2 hours based on protocol

Treatment Goals

• Target glucose range: 140-180 mg/dL for most hospitalized patients 1
• More stringent targets (110-140 mg/dL) may be appropriate for selected patients if achievable without significant hypoglycemia 1
• Avoid using sliding scale insulin as the sole treatment method 1

Important Considerations

• Nutritional status affects dosing frequency:

  • For patients receiving enteral/parenteral nutrition: Insulin should cover basal, prandial, and correction needs 1
  • For patients on glucocorticoids: May require 40-60% higher insulin doses 1

• Hypoglycemia prevention:

  • Monitor closely for glucose <70 mg/dL
  • Have standardized hypoglycemia treatment protocol in place
  • If enteral nutrition is interrupted while on insulin, start 10% dextrose infusion immediately 1

Common Pitfalls to Avoid

1. Using only sliding scale insulin - This reactive approach is strongly discouraged and associated with poor outcomes 1

2. Inadequate monitoring frequency - Severe hyperglycemia requires frequent monitoring until stabilized

3. Failing to adjust for nutritional status - Insulin regimen must match the patient's intake pattern

4. Overlooking basal insulin needs - Even NPO patients require basal insulin coverage, especially those with type 1 diabetes

5. Aggressive overcorrection - Rapid normalization of severely elevated glucose can lead to adverse outcomes; aim for gradual improvement toward target range 1

Remember that persistent hyperglycemia >180 mg/dL is associated with increased mortality and morbidity, including infections and longer hospital stays 2, making prompt and appropriate insulin administration essential for improving outcomes.