Insulin Dosing for Blood Glucose of 332 mg/dL
For a blood glucose of 332 mg/dL, a basal-bolus insulin regimen should be initiated with a total daily dose of 0.3-0.5 units/kg, with half as basal insulin and half as bolus insulin divided among meals. 1
Initial Insulin Dosing Approach
For a patient with severe hyperglycemia (>300 mg/dL), the following approach is recommended:
- Calculate total daily insulin dose: 0.3-0.5 units/kg/day 1, 2
- Distribution: 50% as basal insulin, 50% as prandial (bolus) insulin 1
- For a 70kg adult example:
- Total daily dose: 21-35 units
- Basal component: 10.5-17.5 units
- Prandial component: 10.5-17.5 units (divided into 3-4 doses before meals)
Immediate Management
For the current elevated reading of 332 mg/dL:
- Correction dose: 6-8 units of rapid-acting insulin (such as insulin lispro/Humalog) 2, 3
- Administration timing: Inject immediately 3
- Monitor: Recheck blood glucose in 2-3 hours
Ongoing Management
Basal Insulin
- Start with 0.1-0.2 units/kg for insulin-naive patients 2
- For patients already on insulin with BG >300 mg/dL, use 0.3 units/kg/day 1
- Administer once daily at the same time each day 2
Prandial (Bolus) Insulin
- Divide the remaining 50% of the total daily dose into three pre-meal doses 1
- Administer rapid-acting insulin (lispro, aspart) immediately before meals 3
- Consider higher doses before the largest meal of the day 2
Titration Protocol
- Basal insulin: Adjust every 3 days by 2 units until fasting glucose reaches 80-130 mg/dL 2
- Prandial insulin: Adjust based on post-meal glucose readings
- Correction scale for hyperglycemia 2:
- 150-200 mg/dL: Add 2 units rapid-acting insulin
- 201-250 mg/dL: Add 4 units rapid-acting insulin
- 251-300 mg/dL: Add 6 units rapid-acting insulin
300 mg/dL: Add 8 units rapid-acting insulin
Special Considerations
- Reduced doses (0.1-0.2 units/kg) for elderly patients, those with renal impairment, or poor oral intake 1, 2
- Higher doses may be needed for patients with insulin resistance or on steroid therapy 1
- For patients on high-dose home insulin (>0.6 units/kg/day), reduce the home dose by 20% when initiating hospital treatment 1
Monitoring and Safety
- Monitor for hypoglycemia, especially at night 1
- If hypoglycemia occurs, determine the cause and reduce the corresponding insulin dose by 10-20% 1, 2
- For patients with type 1 diabetes, never use sliding scale insulin alone 1
- Avoid premixed insulin formulations in the acute setting due to higher risk of hypoglycemia 1
Blood glucose of 332 mg/dL requires prompt intervention with insulin therapy to prevent complications such as diabetic ketoacidosis or hyperosmolar hyperglycemic state. The basal-bolus approach provides the most physiologic insulin replacement and has been shown to be more effective than sliding scale insulin alone for managing hyperglycemia.