Pre-Meal Short-Acting Insulin Dosing for Blood Sugar 400-449 mg/dL
For a blood sugar level of 400-449 mg/dL, administer 4 units of short-acting insulin before the meal. 1
Dosing Recommendation Based on Guidelines
The American Diabetes Association (ADA) Standards of Care provides specific guidance for insulin dosing in hyperglycemic states:
- For premeal glucose >350 mg/dL (>19.4 mmol/L), give 4 units of short- or rapid-acting insulin 1
- This recommendation is part of a simplified sliding scale approach while adjusting prandial insulin 1
Considerations for Implementation
Type of Insulin
- Short-acting insulins include regular human insulin
- Rapid-acting insulins include lispro, aspart, and glulisine 1
- Rapid-acting insulin analogues have a faster onset and shorter duration of action than regular human insulin 2
Timing of Administration
- Rapid-acting insulin analogues (lispro, aspart, glulisine) should be administered immediately before meals 2
- Regular human insulin should ideally be administered 30 minutes before meals for optimal effect 3
Monitoring After Administration
- Monitor for signs of hypoglycemia, especially 2-4 hours after administration 4
- Consider checking blood glucose 2 hours post-meal to assess effectiveness of the dose 5
Important Caveats and Precautions
- Avoid using rapid-acting or short-acting insulin at bedtime due to risk of nocturnal hypoglycemia 1
- Blood glucose >400 mg/dL may indicate severe insulin deficiency; consider checking for ketones, especially in type 1 diabetes 1
- For persistent hyperglycemia, reassess the overall insulin regimen rather than simply increasing correction doses 1
- Consider the patient's overall insulin sensitivity when interpreting this recommendation 1
- Patients with recurrent severe hyperglycemia may need adjustment of their basal insulin in addition to prandial insulin 1
Adjusting the Regimen
If hyperglycemia persists:
- Every 2 weeks, adjust insulin dose based on finger-stick glucose testing performed before lunch and before dinner 1
- Goal: 90–150 mg/dL (5.0–8.3 mmol/L) before meals 1
- If 50% of premeal finger-stick values over 2 weeks are above goal, increase the dose or add another agent 1
This recommendation aligns with the ADA's approach to managing hyperglycemia while minimizing the risk of hypoglycemia, which is critical for reducing morbidity and mortality in patients with diabetes 1.