Sometimes, a patient may first arrive in the emergency room and then be diagnosed with diabetes. In such cases, the patient is managed with short-acting insulin according to a sliding scale.
Before every meal, 3 to 4 times a day, the patient’s blood sugar is checked, and short-acting insulin is given according to the sliding scale. Gradually, a steady state is achieved.
Finally, to reduce the number of insulin dosages, the total number of units needed in a day is calculated, and two-thirds of the total dose is given before breakfast as two-thirds long-acting insulin and one-third short-acting insulin. In the evening, the remaining one-third of the dose is given before dinner as a 1:1 ratio of long-acting to short-acting insulin.
For example, let’s assume a patient has been diagnosed with type 1 diabetes after arriving in the emergency room with diabetic ketoacidosis. After four days, the patient has stabilized on 48 units per day of Actrapid. Before discharging the patient, we need to optimize the insulin schedule. We will give two-thirds of the dose (32 units) in the morning as 22 units of long-acting insulin and 10 units of short-acting insulin. In the evening, we will give one-third of the dose (16 units) as 8 units of long-acting insulin and 8 units of short-acting insulin.