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Related Concept Videos

Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Insulin Formulations: Types and Delivery01:27

Insulin Formulations: Types and Delivery

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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into...
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Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Diabetes Mellitus: Overview and Type I Subtype01:22

Diabetes Mellitus: Overview and Type I Subtype

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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
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Diabetes Mellitus: Type 2 and Gestational01:22

Diabetes Mellitus: Type 2 and Gestational

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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Related Experiment Video

Updated: Sep 18, 2025

Improving IV Insulin Administration in a Community Hospital
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Novel Inpatient Automated Self-Adjusting Subcutaneous Insulin Algorithm: 3-Year Experience. An Observational Study.

Robert J Rushakoff1, Esther Rov-Ikpah2, Gwendolyn Lee3

  • 1Division of Endocrinology and Metabolism, University of California, San Francisco, CA 94115, USA.

The Journal of Clinical Endocrinology and Metabolism
|June 24, 2025
PubMed
Summary

An automated subcutaneous rapid acting insulin algorithm (SQIA) improved glucose control in hospitalized patients unable to eat, significantly reducing both hypoglycemia and severe hyperglycemia compared to conventional insulin treatment.

Keywords:
inpatient diabetes managementnil per osphysician efficiencyself-adjusting insulin administrationtotal parenteral nutritiontube feeding

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Area of Science:

  • Inpatient glycemic management
  • Medical device technology
  • Electronic Medical Record (EMR) integration

Background:

  • Managing blood glucose in hospitalized patients who are nil per os (NPO), on enteral tube feeds (TF), or total parenteral nutrition (TPN) is complex.
  • Conventional insulin treatment (CI) often struggles to maintain optimal glycemic control in these patient populations.

Purpose of the Study:

  • To evaluate the efficacy of a novel automated self-adjusting subcutaneous rapid acting insulin algorithm (SQIA) for inpatient hyperglycemia management.
  • To compare glucose control outcomes between SQIA and CI in NPO, TF, or TPN patients.

Main Methods:

  • Retrospective cohort study utilizing EMR data from September 2020 to September 2023.
  • Compared point-of-care (POC) glucose measurements in adult inpatients on SQIA versus CI.
  • Analyzed proportions of POC glucose levels in hypoglycemic, in-range, and hyperglycemic categories (q4 hour intervals).

Main Results:

  • The SQIA group demonstrated significantly lower proportions of hypoglycemic (0.65% vs. 1.10%) and severely hyperglycemic (5.40% vs. 6.65%) glucose values compared to the CI group.
  • SQIA showed particular benefit in reducing severe hyperglycemia in patients receiving glucocorticoids, especially at high doses (-11.1%).
  • The study analyzed 5,031 intervals across 4310 hospitalizations.

Conclusions:

  • Automated SQIA significantly improves glycemic control in hospitalized patients unable to eat, drink, or take oral medications.
  • SQIA reduces the risk of both hypoglycemia and severe hyperglycemia compared to conventional insulin orders.
  • This technology offers a promising advancement in managing challenging inpatient glycemic control scenarios.