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Additional doses of rapid-acting insulin (NovoRapid, Humalog or Apidra) can be combined with bolus insulin to correct pre-meal hyperglycaemia
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Needs to be administered separately if on basal or premixed insulin
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NB: Basal insulin or premixed insulin should not be used for correction insulin
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Use 1 unit for every X mmol > 8 mmol/L based on the total daily dose (TDD) of both basal +bolus insulin
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TDD ≤ 25 units/day → correction doses by 1 unit for every 4 mmol > 8 mmol/L
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TDD 26 – 40 units/day → correction doses by 1 unit for every 3 mmol > 8 mmol/L
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TDD 41 – 75 units/day → correction doses by 1 unit for every 2 mmol > 8 mmol/L
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TDD ≥ 76 units/day → correction doses by 1 unit for every 1 mmol > 8 mmol/L
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Often safer to initially limit the maximal correction dose to 6 – 10 units
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Correction insulin may also be added at other times (e.g. before bed) as long as > 3 hours between correction doses
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Frequent use of correction insulin suggests increases in doses of the normal insulin regimen are required
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An example of how to use correction insulin is shown here
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An example of how to use correction insulin
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If a patient is on 40 units of basal insulin nocte and 10 units of bolus insulin with meals their TDD is 70 units per day, so their starting correction is 1 unit for every 2 mmol > 8 mmol/L
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A table can then be provided for the combined doses of bolus + correction insulin at each meal e.g.:
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Blood glucose level
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Correction dose of insulin
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Total insulin dose with meal
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< 10 mmol/L
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0
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10 units
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10 – 11.9 mmol/L
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1
|
11 units
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12 – 13.9 mmol/L
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2
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12 units
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14 – 15.9 mmol/L
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3
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13 units
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16 – 17.9 mmol/L
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4
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14 units
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18 – 19.9 mmol/L
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5
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15 units
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≥ 20 mmol/L
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6
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16 units
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