Insulin Dosing for Pre-Meal Blood Sugar of 400-449 mg/dL
For a pre-meal blood sugar of 400 to 449 mg/dL, administer 4 units of rapid-acting insulin. 1, 2
Dosing Approach for High Blood Glucose
- For pre-meal glucose >350 mg/dL (>19.4 mmol/L), give 4 units of rapid-acting insulin 2, 1
- This simplified approach is recommended by the American Diabetes Association for managing significant hyperglycemia 2
- The dose should be administered immediately before the meal when using rapid-acting insulin analogs 1
Considerations for Ongoing Management
- After addressing the immediate high blood glucose, assess the adequacy of the overall insulin regimen 2
- If the patient is already on basal insulin, evaluate for clinical signs of inadequate dosing (elevated bedtime-morning differentials, high variability) 2
- For patients requiring regular correction of high blood glucose, consider adding scheduled prandial insulin to their regimen 2
Titration Strategy
- For ongoing prandial insulin management, increase dose by 1-2 units or 10-15% twice weekly if blood glucose remains elevated 2
- If hypoglycemia occurs, determine the cause and reduce the corresponding dose by 10-20% 2
- Target pre-meal glucose values of 90-150 mg/dL (5.0-8.3 mmol/L) for most patients 2
Special Considerations for Older Adults
- In older adults, a simplified sliding scale approach is appropriate with 4 units for glucose >350 mg/dL 2
- Avoid rapid-acting insulin at bedtime due to increased risk of nocturnal hypoglycemia 2
- For older adults with complex health issues, consider higher glycemic targets (e.g., <8.0% A1C) to reduce hypoglycemia risk 2
Advantages of Rapid-Acting Insulin
- Rapid-acting insulin analogs (lispro, aspart, glulisine) have faster onset and shorter duration than regular human insulin 3
- This pharmacokinetic profile better matches nutrient absorption from meals 4
- The shorter duration reduces risk of late postprandial hypoglycemia 5