Once the patient starts to eat and drink conversion back to subcutaneous insulin injections is undertaken as follows.
• Always change to subcutaneous insulin before breakfast and never in the evening so that adequate supervision can be assured.
• Stop the insulin pump 30 minutes after the first subcutaneous insulin injection.
• Insulin regimen and dose: if the previous regimen is known then this should be given; if the patient is still in bed or unwell the total dose may need to be 10 to 20% more than usual. If the patient was not previously taking insulin, predicting the requirement is not easy and the amount needs adjustment from day to day. Initially use insulin 30-40 units daily in divided doses given four times daily.
Patients with hyperglycaemia often relapse after conversion back to subcutaneous insulin. When this happens there are three possible approaches.
• Give additional doses of soluble insulin at any of the four injection times (before meals or bedtime).
• Add an intravenous insulin infusion temporarily while continuing the subcutaneous regimen until the blood glucose concentration is satisfactory.
• Revert completely to the intravenous regimen, especially if the patient is unwell.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...