PHYSICIAN’S ORDERS
Insulin and Blood Glucose Monitoring Orders
LAB ORDERS
Blood Glucose Monitoring:
Before Meals and at Bedtime
Every 6 hours (NPO)
Fasting Lipid Profile
Albumin/Creatinine Ratio
A1C
Other:
Select Appropriate Regimen(s):
*(See General Insulin Dosing Recommendations on reverse side)
Prandial
Insulin
Orders
(Meal times)
Breakfast
Lunch
Dinner
Bedtime
Give _____units
Lispro (Humalog)
Give _____units
Lispro (Humalog)
Give _____units
Lispro (Humalog)
Give _____units
Lispro (Humalog)
0-15 minutes
before eating
0-15 minutes before
eating
Aspart (Novolog)
0-15 minutes before
eating
U-100 Regular
U-100 Regular
30 minutes before
eating
Basal
Insulin
Orders
Aspart (Novolog)
0-15 minutes before
eating
0-15 minutes
before eating
Aspart (Novolog)
0-15 minutes before
eating
U-100 Regular
30 minutes before
eating
Give _____units
NPH
Give 1-2 times daily
U-100 Regular
30 minutes before
eating
Give _____units
NPH
Give _____units
NPH
Glargine* (Lantus)
Usually once a day
dosing
*Do Not mix with
any other insulin
Aspart (Novolog)
0-15 minutes before
eating
30 minutes before
eating
Give 1-2 times daily
Glargine* (Lantus)
0-15 minutes before
eating
Usually once a day
dosing
*Do Not mix with
any other insulin
Give 1-2 times daily
Glargine* (Lantus)
Usually once a day
dosing
*Do Not mix with any
other insulin
Supplemental (Correction)
BEFORE MEALS:
Lispro (Humalog)
Aspart (Novolog)
U-100 Regular
It is recommended that analog doses (Novolog Humalog) be given at least 3 hours apart and regular insulin at
least 4 hours a part.
Low Dose

Medium Dose
(patient is average or
overweight, eating
and requires 40-80
units of insulin daily)
High Dose
Blood
Sugar
(patient is thin,
NPO, elderly or
requires 0-40 units
insulin daily)
(patient on steroids,
with sepsis or
requires 80 units of
insulin daily)
<80
80 – 150
150 -199
200 – 249
250 – 299
300 – 349
350 – 399
> 400
 Follow Guidelines for Correction below
No insulin
No insulin
No insulin
1 unit
1 unit
2 units
2 units
3 units
4 units
3 units
5 units
7 units
4 units
7 units
10 units
5 units
8 units
12 units
Call Physician
Individualized
Patient Dosing
Night/
Bedtime
Dose
(Optional)
No insulin
No insulin
1 unit
2 units
3 units
4 units
Resume patient on usual home dose of insulin as soon as feasible.
Guidelines for Correction:
For blood glucose less than 80 mg/dl, use Hypoglycemia Protocol below:
1. If patient can take PO, give 15 grams of fast-acting carbohydrate (4 oz fruit juice/non-diet soda, 8 oz. nonfat
milk, or 3-4 glucose tablets).
2. If patient cannot take PO, give 25 ml of D50 as IV push
3. Check finger stick glucose every 15 minutes and repeat above if blood glucose is less that 80 mg/dl
4. Call physician.
Date/Time: _________________________Physician Signature____________________________________________
Addressograph/ ID Sticker
Insulin Orders 2/12/2016
General Insulin Dosing Recommendations:
A. Patients with Type 1 Diabetes
a. When admitting a patient with Type 1 diabetes, continue the basal insulin that they
were taking at home at the same dose. May use an insulin drip rather than
subcutaneous insulin. The prandial insulin (Regular/Lispro/Aspart) may require
adjustment depending on the patient’s situation. If the patient is eating much less, the
prandial insulin will need to be reduced. Many hospitalized patients are under
significant metabolic stress (infection, glucocorticoids, etc.) and may require larger
doses of prandial insulin despite eating less.
b. The usual daily insulin requirement for patients with Type 1 diabetes is 0.5-0.7
units/kg/day, however, newly diagnosed patients typically produce some insulin, and
thus the daily insulin requirement is 0.3-0.5 units/kg/day. Half or 50% should be given
as basal insulin and the remainder as prandial insulin.
B. Patients with Type 2 Diabetes
a. If patient is using insulin at home, continue the outpatient regimen and adjust as
needed.
b. If patient was not previously on insulin, but will need both prandial and basal insulin,
start with a daily insulin requirement of 0.3 units/kg/day. Daily insulin requirements in
Type 2 diabetes can exceed 1 unit/kg/day in some patients.
Insulin Orders 2/12/2016