A. Rapid insulin dose to correct increased blood glucose (Target level 5.5-7.0 mmo1/L)   Monitoring and insulin injection Glucose control 4 times per day every 4 hours every 2 hours Glucose range (mmol/L) 4.1-7.0 7.1-9.0 9.1-13.0 13.1-16.0 16.1-19.0 19.1-21.0 21.0 Insulin units 0 1 2 3 4 5 6

B. Rapid insulin dose to cover meal carbohydrate intake Meal size Insulin units (carbohydrates in g)   breakfast lunch dinner late snack 1200 kcal 3 (30) 3 (30) 3 (30) 1 (10) 1600 kcal 4 (40) 4 (40) 4 (40) 1 (10) 2000 kcal 5 (50) 5 (50) 5 (50) 2 (20) 2400 kcal 6 (60) 6 (60) 6 (60) 2 (20) Total rapid insulin dose (A + B) * resistance factor = total insulin units Generally, start with resistance factor 1. In high-acuity patients (e.g., those with sepsis or systemic inflammation), patients with corticosteroid treatment or in patients on high pre-admission insulin doses, a higher starting insulin resistance factor may be considered.

Table 1: “Improved” sliding scale insulin protocol incorporating nutritional factors and insulin resistance as well as glucose levels for insulin dosing.