Correction Insulin Dosing for Blood Glucose of 280 mg/dL
For a hospitalized non-critically ill patient with a blood glucose of 280 mg/dL, administer 10 units of regular insulin subcutaneously using a standardized correction scale: 5 units for every 50 mg/dL above 150 mg/dL, which equals 10 units for a glucose of 280 mg/dL (130 mg/dL above threshold ÷ 50 = 2.6 increments × 5 units = approximately 10 units). 1
Standard Correction Dosing Algorithm
The American Diabetes Association provides clear guidance for supplemental regular insulin in hospitalized adults:
- Start correction at glucose >150 mg/dL 1, 2
- Give 5-unit increments for every 50 mg/dL increase above 150 mg/dL 1
- Maximum single dose: 20 units for glucose ≥300 mg/dL 1
For your patient with glucose of 280 mg/dL:
- 280 - 150 = 130 mg/dL above threshold
- 130 ÷ 50 = 2.6 increments
- 2.6 × 5 units = 13 units (round to 10-15 units depending on insulin sensitivity) 1
Critical Context: This Is NOT Standalone Therapy
Sliding scale insulin (SSI) alone is strongly discouraged as the sole method of insulin treatment in hospitalized patients. 3 This correction dose should be part of a basal-bolus regimen, not used in isolation. 3
When Correction Insulin Is Appropriate:
- Post-DKA resolution in NPO patients: Regular insulin every 4-6 hours as needed while maintaining IV fluids 2
- As supplemental coverage: Added to scheduled basal and nutritional insulin 3
- Temporary bridge: While establishing a comprehensive insulin regimen 1
Timing and Administration
- Regular insulin: Administer subcutaneously every 6 hours as needed 1
- Rapid-acting insulin alternative: Can be given every 4 hours instead 1
- Expect meal within 30 minutes if using regular insulin 4
Target Glucose Ranges
For non-critically ill hospitalized patients:
- Premeal target: <140 mg/dL 3
- Random glucose target: <180 mg/dL 3
- Reassess regimen if glucose <100 mg/dL 3
- Modify regimen required if glucose <70 mg/dL 3
Common Pitfalls to Avoid
Never rely on correction insulin alone. The most common error is using SSI as monotherapy rather than establishing a proper basal-bolus regimen. 3 This reactive approach leads to:
- Persistent hyperglycemia between correction doses
- Glucose variability and "roller coaster" patterns
- Failure to address underlying insulin deficiency
- Increased risk of both hyper- and hypoglycemia 3
Do not use this dosing in DKA. If this patient has diabetic ketoacidosis, completely different protocols apply with continuous IV insulin infusion at 0.1 units/kg/hour. 5
Account for insulin resistance factors. Patients on high-dose corticosteroids, with obesity, or during acute illness may require higher correction doses. 6
Next Steps After Correction Dose
Within 24 hours, establish a scheduled insulin regimen: