Diabetes and COVID-19

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U 500 insulin use in the hospital setting

  • 1.  U 500 insulin use in the hospital setting

    Posted 10-09-2020 07:46
    I am reaching out to find out if anyone has a formula for converting U 500 Humulin to U 100 Humalog for patients admitted in the hospital and established on a U 500 regimen at home.

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    Shesha Desai
    RWJ UNIV HOSPITAL HAM
    Hamilton NJ
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  • 2.  RE: U 500 insulin use in the hospital setting

    Posted 10-10-2020 14:25
    At our hospital, we usually reduce the TDD by 50% and then split that 50/50 basal bolus regimen. We often use NPH for basal to facilitate transition to back to home regimen. Hope this helps!

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    Paulina Cruz Bravo, MD (she/her/hers)
    Assistant Professor of Medicine
    Division of Endocrinology, Metabolism and Lipid Research
    Washington University School of Medicine
    Campus Box 8127
    660 S. Euclid Ave
    St. Louis, MO 63110

    Email: pcruz@wustl.edu
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  • 3.  RE: U 500 insulin use in the hospital setting

    Posted 10-10-2020 15:06
    no formula but here are the basic teaching points we give to our fellows:
    • no scheduled insulin if NPO
    • do not use U500 with tube feeds
    • consider starting  correction dosing at 1 unit for every  25 if > 150 when NPO
    • if PO intake initiated and glucose starting to rise consider using carb ratio of 5 as starting point (we dose based on carbs consumed in our hospital) 
    • do not resume U500 until clearly tolerating PO intake and BG consistently > 200
      • when ready to resume U500 negotiate dose with patient as they will know if ready to resume home dosing


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    Kittie Wyne, MD, PhD, FACE
    COLUMBUS OH
    kittiewyne@hotmail.com
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  • 4.  RE: U 500 insulin use in the hospital setting

    Posted 10-10-2020 21:28
    1. Calculate the total daily dose of U500
    2. Multiply TDD by 5--> this is now the "new TDD" in U100
    3. 50% of the "new TDD" is the basal insulin dose (choose any basal you have available, if you use NPH you can give it Q12 or Q8 hours)

    4. Now the remaining 50% is correction / nutrition  dose

    5. To calculate the nutrition insulin requirement, calculate the insulin to carb ratio (500/TDD)
    6. To calculate the correction factor use 1500/TDD (some use 1800/TDD or 1700/ TDD)

    With this information you can build:
    Basal dose
    Mealtime dose of U500
    Correction dose of U500

    Hope this helps.
    Samar

    Samar Hafida , MD

    Staff Endocrinologist/ Adult Diabetes ,weight management and clinical nutrition specialist

    Assistant Medical Director, Global Education & Care

    Clinical Instructor Harvard School of Medicine

     

    Joslin Diabetes Center 

    One Boston Place 

    Boston, MA   02215

    Tel: (617) 309-2665

    Fax: ((617) 309-2734

     

     



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    Samar Hafida
    BOSTON MA
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  • 5.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 07:49
    Thank You all for your prompt and very informative responses.
    These are very valuable suggestions and makes my decision much easier now.
    We currently have U 500 pens in our hospital strictly linited to Endo use only.
    However we are looking at taking it off formulary and I wanted a concrete plan before we go that route.
    You all were very helpful.
    Thank You
    Shesha

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    Shesha Desai
    RWJ UNIV HOSPITAL HAM
    Hamilton NJ
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  • 6.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 11:19
    Shesha,
    we do not have the pens in our hospital.
    we keep a vial in the central pharmacy.
    the dose is sent up in the dedicated "green" syringe.
    it used to be that the nurse had to order the dose but that led to delays so the dose is sent up at standard meal times. this meals we can not change the dose within about 2 hours of the meal time. I think this is reasonable.
    we do have it restricted such that only endocrinology can order or change a dose.
    we also have as part of our order set/protocol that the Pharmacist interview the patient prior to the first dose.
    kw

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    Kittie Wyne, MD, PhD, FACE
    Professor, Division of Endocrinology
    The Ohio State University
    Columbus OH
    kittiewyne@hotmail.com
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  • 7.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 08:00

    Thank You

     

    Shesha Desai. Pharm D. Rph.BC-ADM | Diabetes Program Coordinator/ Staff Pharmacist / ADR Coordinator
    Phone: 609-249-7509, 609-584-6575 | Fax: 609-584-6745 | S
    hesha.Desai@rwjbh.org

     

     






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  • 8.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 10:14
    This was very helpful to me as well. I get this questions from my physicians often. Thank ​you. Tracy Schneider

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    Tracy Schneider
    TROY OH
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  • 9.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 10:24

    I would just caution that if you are already using U-500 pens or U-500 syringes, there's no need to multiply the dose by 5.

    In our hospital, we have kept it on formulary despite low use. Maybe 1-2 patients per month, but often these patients really need it. We use vials to control cost (instead of single-patient use pens) and U500 syringes. The dose is drawn by pharmacy. We have shown this process to be safer. It also requires an Endocrinology consult.

    Deal EN, Tobin GS. Policy implementation for inpatient management of U-500 insulin resulting in lower incidence of hypoglycemia. Endocr Pract. 2011 May-Jun;17(3):521. PMID: 21700563.

    Regards,
    PCB 



    ------------------------------
    Paulina Cruz Bravo, MD (she/her/hers)
    Assistant Professor of Medicine
    Division of Endocrinology, Metabolism and Lipid Research
    Washington University School of Medicine
    Campus Box 8127
    660 S. Euclid Ave
    St. Louis, MO 63110

    Email: pcruz@wustl.edu
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  • 10.  RE: U 500 insulin use in the hospital setting

    Posted 10-12-2020 10:36
    Thank you.  That reference is very helpful

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    [Shesha Desai, Pharm D, Rph .BC-ADM
    RWJ Barnabas Health Systems.
    Hamilton, NJ
    [Phone]
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