What is the schedule for administering correctional insulin (correction insulin)?

Correctional Insulin Administration Schedule

Correctional insulin should be administered subcutaneously every 6 hours when using regular human insulin or every 4 hours when using rapid-acting insulin analogs. 1

Timing of Correctional Insulin Administration

The schedule for correctional insulin administration depends on the type of insulin used:

• Regular human insulin: Administer every 6 hours

  • Onset of action: 15-30 minutes
  • Peak action: 3-4 hours
  • Duration of action: 6-8 hours 2

• Rapid-acting insulin analogs (lispro, aspart, glulisine): Administer every 4 hours

  • Onset of action: 5-15 minutes
  • Peak action: 1-2 hours
  • Duration of action: 3-4 hours 2

Implementation in Hospital Settings

In hospital settings, correctional insulin is typically incorporated into insulin regimens that include:

1. Basal insulin: Long-acting insulin to provide background insulin coverage
2. Nutritional/prandial insulin: To cover meals or nutritional support
3. Correctional insulin: To address hyperglycemia between scheduled insulin doses

For patients receiving enteral or parenteral nutrition, correctional insulin is particularly important as part of a comprehensive insulin regimen that addresses basal, prandial, and correctional needs 1.

Special Considerations

Enteral/Parenteral Nutrition

• For patients on continuous enteral/parenteral nutrition, correctional insulin should be administered according to the standard schedule (every 6 hours for regular insulin) 1
• If enteral nutrition is interrupted, a 10% dextrose infusion should be started immediately to prevent hypoglycemia 1

Glucocorticoid Therapy

• Patients on glucocorticoid therapy often require higher doses of correctional insulin due to steroid-induced hyperglycemia 1
• The timing of correctional insulin remains the same, but dose adjustments are frequently needed 1

Clinical Pitfalls to Avoid

1. Stacking insulin: Administering correctional insulin more frequently than recommended can lead to insulin stacking and hypoglycemia

2. Failure to adjust doses: Correctional insulin doses should be adjusted based on patient response and glycemic patterns

3. Ignoring patterns: Repeated need for correctional insulin suggests that basal or nutritional insulin doses need adjustment

4. Delayed administration: Ensure timely administration of correctional insulin to effectively manage hyperglycemia

5. Neglecting type 1 diabetes patients: Patients with type 1 diabetes must always receive basal insulin, even if feedings are discontinued, to prevent diabetic ketoacidosis 1

By following the appropriate administration schedule for correctional insulin based on the type of insulin used, healthcare providers can effectively manage hyperglycemia while minimizing the risk of hypoglycemia in hospitalized patients.