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Basal & Long-Acting Insulins
Unless on high dose vasopressors or have widespread oedema, patients with Type 1 or Type 2 Diabetes should continue 80% of their normal basal insulin once enteral feed or TPN is established.
Increases of basal insulin doses should be gradual (ideally every 48-72 hours) as a blood glucose trend is established and calorie intake increases. The dose increase should not be by more than 50% of the current dose. Dose changes are ideally led by the Diabetes Specialist Team.
Patients with an insulin pump should, in general, have their pump removed on admission and switched to a variable rate insulin infusion. If disconnected, basal insulin will need to be prescribed in its absence and the Diabetes Team should be consulted as soon as possible. See hospital protocol on the intranet for the adult insulin pump policy.
Basal insulins should be administered to the abdomen, legs or buttocks away from sites of scarring, lipohypertrophy (hard lumps) and sites of infection.
Basal insulin should not be started for patients in critical care who are felt to have hyperglycaemia secondary to critical illness, in whom HBA1c < 53mmol/mol and are non-diabetic. Hyperglycaemia is likely to be transient and resolve when critical illness resolves. In steroid-induced hyperglycaemia, basal insulins should be considered with caution as hyperglycaemia may resolve after stopping therapy. Basal insulin may be commenced after consultation with the Diabetes Specialist Team and consideration of the likelihood for need for medium to long-term treatment.
Insulin requirements may fall rapidly on resolution of critical illness and should prompt review of basal insulin dose if blood glucose is persistently below the target range (6.0 - 10.0 mmol/L)
Nasogastric or enteral feeding can influence the choice of basal insulin and regimen prescribed. This is usually dependant on the feeding regimen. Any subsequent changes to enteral feeding regimen or times will require a review of the current insulin therapy.