What dose of Humulin R (regular insulin) is recommended for a patient with hyperglycemia of 360 mg/dL?

Management of Hyperglycemia with Blood Glucose of 360 mg/dL

For a patient with a blood glucose of 360 mg/dL, administer 5-10 units of Humulin R (regular insulin) subcutaneously as an initial dose, with subsequent monitoring and adjustment based on response. 1, 2

Initial Insulin Dosing for Hyperglycemia of 360 mg/dL

• For non-DKA hyperglycemia of 360 mg/dL, regular insulin (Humulin R) can be administered subcutaneously every 6 hours for hyperglycemia correction 2
• In adult patients, regular insulin can be given in 5-unit increments for every 50 mg/dL increase in blood glucose above 150 mg/dL, up to 20 units for blood glucose of 300 mg/dL 3, 2
• For a blood glucose of 360 mg/dL (which is 210 mg/dL above the 150 mg/dL threshold), this would translate to approximately 20 units plus an additional 2-4 units for the increment above 300 mg/dL 3, 2
• However, for initial management in insulin-naive patients, a more conservative approach starting with 5-10 units is recommended to avoid hypoglycemia 1

Monitoring After Initial Dose

• After administering the initial dose, blood glucose should be monitored hourly until it begins to decrease significantly 1
• If blood glucose remains severely elevated after 2 hours, additional correctional doses may be needed 1, 2
• Watch for signs of rapid blood glucose decline which could lead to hypoglycemia, especially if the patient has impaired kidney function 1

Adjustment Based on Patient Factors

• For patients who are insulin-naive or elderly, start with the lower end of the dosing range (5 units) 1, 2
• For patients already on insulin therapy, a dose of 10% of their total daily insulin requirement or 0.1 units/kg body weight can be appropriate 1
• For patients with known insulin resistance requiring >200 units/day, higher initial doses may be necessary 4, 5

Special Considerations

• Assess for potential causes of hyperglycemia (infection, medication non-adherence, new-onset diabetes) 1
• For patients with type 1 diabetes or those at risk for DKA, check for ketones 1
• If the patient shows signs of altered mental status, severe dehydration, or ketoacidosis, consider intravenous insulin administration instead of subcutaneous injection 1, 3
• If the hyperglycemia is occurring in a hospitalized patient on enteral or parenteral nutrition, adjust insulin dosing according to feeding schedule 3, 2

Transition to Maintenance Therapy

• Once blood glucose falls below 300 mg/dL, adjust to less frequent monitoring (every 2-4 hours) 1, 2
• When the patient is able to eat, transition to a multiple-dose schedule using a combination of short/rapid-acting and intermediate/long-acting insulin 3, 2
• For long-term management, basal insulin is typically started at a low dose (0.1-0.2 U/kg/day), with titration based on fasting glucose levels 3

Common Pitfalls to Avoid

• Avoid delaying insulin therapy in patients with severe hyperglycemia, as this can lead to metabolic decompensation 1
• Do not rely solely on sliding scale insulin without addressing basal insulin needs if the patient requires ongoing management 1, 2
• Be cautious about stacking insulin doses (giving additional doses before the first has had time to take full effect), which can lead to severe hypoglycemia 1