Tresiba Dose Reduction After D5 Discontinuation
Immediate Recommendation
Reduce Tresiba by 4 units (from 20 to 16 units) immediately, given the discontinuation of D5 infusion and current blood glucose levels of 125-127 mg/dL. 1
Rationale for This Specific Reduction
The patient's blood glucose levels overnight (125-127 mg/dL) are already at the lower end of acceptable fasting targets (80-130 mg/dL), and removing the D5 infusion eliminates approximately 120 grams of glucose per 24 hours that was previously requiring insulin coverage 2. A 20% reduction (4 units from 20 units) is the standard approach when discontinuing a continuous glucose source to prevent hypoglycemia 2, 1.
Key Principles for Insulin Adjustment When Stopping Dextrose
When discontinuing IV dextrose in hospitalized patients, basal insulin should be reduced by 10-20% immediately to prevent hypoglycemia 2, 1
The 20% reduction rule applies specifically when removing a continuous carbohydrate source - D5 at 100 mL/hr provides continuous glucose that was being covered by the current Tresiba dose 2
Blood glucose values of 125-127 mg/dL indicate the current regimen is already achieving tight control, making the patient vulnerable to hypoglycemia once the glucose infusion stops 2
Monitoring Requirements After Adjustment
Check blood glucose every 4-6 hours for the first 24 hours after discontinuing D5 to ensure the dose reduction is adequate 2
If blood glucose rises above 180 mg/dL consistently, increase Tresiba by 2 units every 3 days until fasting glucose returns to 80-130 mg/dL target 1
If blood glucose falls below 70 mg/dL, reduce Tresiba by an additional 2 units (10% further reduction) 2, 1
Critical Pitfall to Avoid
Do not continue the same Tresiba dose after stopping D5 - this is a common error that leads to iatrogenic hypoglycemia in hospitalized patients 2. The continuous glucose infusion was providing substrate that required insulin coverage; removing it without adjusting insulin creates a mismatch that predictably causes hypoglycemia 2.
Alternative Consideration
If the patient has poor or unpredictable oral intake, consider a more conservative reduction to 15 units (25% reduction) rather than 16 units, as elderly patients or those with renal impairment are at higher risk for hypoglycemia 1.