Table 5

Strategies to replace SSI in LTC

Current regimenSuggested steps
SSI is the sole mode of insulin treatment• Review average daily insulin requirement over prior 5–7 days
• Give 50–75% of the average daily insulin requirement as basal insulin
• Stop SSI
• Use noninsulin agents or fixed-dose mealtime insulin for postprandial hyperglycemia
• Consider giving basal insulin in the morning to impact postprandial hyperglycemia and reduce risk of early-morning hypoglycemia
SSI is being used in addition to scheduled basal insulin• Add 50–75% of the average insulin requirement used as SSI to the existing dose of basal insulin
• Use noninsulin agents or fixed-dose mealtime insulin for postprandial hyperglycemia
SSI is being used in addition to basal and scheduled meal time insulin (i.e., correction dose insulin)• If correction dose is required frequently, add the average correction dose before a meal to the scheduled mealtime insulin dose at the preceding meal. For example, if glucose values are consistently elevated before lunch or dinner requiring 2–3 unit corrections, the scheduled breakfast or lunchtime dose of insulin could be increased by the average correction dose (2 units), respectively. Similarly, if glucose values are consistently elevated before breakfast requiring correction doses, the scheduled basal insulin dose could be increased by the average correction dose used
SSI is used in short term due to irregular dietary intake or due to acute illness• Short-term use may be needed for acute illness and irregular dietary intake
• As health and glucose levels stabilize, stop SSI and return to previous regimen as tolerated
Wide fluctuations in glucose levels in patients with cognitive decline and/or irregular dietary intake on a chronic basis• Use scheduled basal and mealtime insulin based on individual needs with the goal of avoiding hypoglycemia
• May use a simple scale, such as “give 4 units of mealtime insulin if glucose >300 mg/dL”
• Keep patients hydrated, especially when glucose levels are high (e.g., >300 mg/dL)