May 18, 2005
Hyperglycemia and DKA, Insulin Analogs
Question from Verona, New Jersey, USA:
Just before bed, my daughter had a blood glucose of 325 mg/dl [18.1 mmol/L] this evening. She had her Lantus and a small low carbohydrate meal. She appears to be getting a cold. She has a stuffy nose and some coughing. Should she have been given another shot of the short-acting insulin and then her long-acting insulin or should she have been given the long-acting insulin, then checked in an hour? She takes Lantus and Humalog.
Answer:
Our recommendation in such circumstances would be to check for urinary ketones and, if moderately or strongly positive, a “sick day” bolus of fast-acting insulin, such as. Humalog, should be given. Your diabetes team can advise you about the appropriate dose, but a safe rule of thumb is a seventh of the total daily insulin dose.
KJR
