What is the expected decrease in blood glucose level with 10 units of insulin for a patient with hyperglycemia (elevated blood glucose level) of 250 milligrams per deciliter (mg/dL)?

From the Guidelines

For someone with a starting blood glucose of 250 mg/dL, 10 units of rapid-acting insulin might lower their blood sugar by approximately 50-100 mg/dL, though this is highly variable. This estimate uses the common starting point that 1 unit of insulin may lower blood glucose by about 5-10 mg/dL, but individual insulin sensitivity differs greatly based on factors like weight, insulin resistance, activity level, stress, illness, and concurrent medications 1. It's essential to work with a healthcare provider to determine your personal insulin sensitivity factor rather than using general estimates. Some key points to consider when managing high blood glucose include:

• Starting with a low dose of basal insulin or oral antidiabetic agents for mild hyperglycemia, and adjusting as needed based on blood glucose levels 1
• Using correction doses with rapid-acting insulin before meals or every 6 hours for moderate hyperglycemia 1
• Implementing a basal-bolus regimen for severe hyperglycemia, with adjustments made as needed 1 Self-adjusting insulin doses without medical guidance can be dangerous and lead to severe hypoglycemia. If you're trying to manage high blood glucose, contact your healthcare provider immediately for personalized advice on appropriate insulin dosing for your specific situation. Key considerations for insulin therapy include:
• The type and dose of insulin used
• The frequency and timing of insulin administration
• The individual's insulin sensitivity and response to therapy
• The presence of any underlying medical conditions or concurrent medications that may affect insulin therapy 1

From the Research

Blood Glucose Reduction with Insulin

• The study 2 found that the median blood glucose change over 6 hours was -24 mg/dL (IQR -53 to 6 mg/dL) after administering 10 units of intravenous regular insulin plus 25 g of intravenous dextrose.
• Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient -0.36,95% CI -0.55 to -0.18, p<0.001) 2.
• For a patient with a blood glucose level of 250 mg/dL, the expected reduction in blood glucose level after 10 units of insulin is variable, but based on the study 2, it could be estimated to be around 24-53 mg/dL.

Factors Affecting Blood Glucose Reduction

• The study 3 suggests that several factors can affect the risk of hypoglycemia, including low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight.
• The study 3 also recommends using insulin 5 units or 0.1 units/kg instead of 10 units, administering dextrose 50 g instead of 25 g, or administering dextrose as a prolonged infusion instead of a rapid intravenous bolus to reduce the risk of hypoglycemia.

Insulin Infusion Protocols

• The study 4 describes an insulin infusion protocol for critical care units, which allows adjustments in insulin administration to be based on changes in capillary blood glucose values since the previous blood glucose measurement.
• The protocol aims to maintain a targeted blood glucose concentration range of 80-130 mg/dL, and the infusion rate is decreased by 0.5 or 1 unit/hr if the blood glucose level continues to decrease over three consecutive measurements 4.