The next step for inpatient insulin dosing: using carbohydrate to insulin ratios

Abstract

Many out patients with diabetes have a successful history of self-adjusting their prandial (mealtime) insulin doses by counting the actual amount of carbohydrates they plan to consume and then individualizing the amount of their insulin dose accordingly. In contrast, hospitalized patients are typically prescribed doses of prandial insulin in advance, based on a predetermined amount of carbohydrate to be provided rather than individualized to the actual carbohydrate consumed. Adjustment of prandial insulin doses is especially important for hospitalized patients because inconsistent food intake often occurs due to interruptions for tests, procedures and changes in appetite. Glucose results are less likely to be optimal when prandial insulin is administered without customized consideration for the ratio of pre-planned insulin doses to be delivered, and the patient’s actual carbohydrate intake. One way to optimize a match between the ideal insulin dose required and the actual foods consumed is to count the amount of carbohydrates before administering the insulin. Dosing insulin by carbohydrate counting is the standard of excellence for best practice in diabetes care [1]. Many patients have mastered this essential component of diabetes self-management skills and appreciate the benefit of this practice by avoiding “serious complications of diabetes that may ensue when glycemic targets aren’t achieved” [2].