Note: Administer 10 to 15 U intermediate-acting or long-acting insulin upon awakening and/or bedtime. Reduce NPH dose if hypoglycemia present at 0330.

Administer oral glucose or 20 to 40 ml 50% glucose solution (IV) for hypoglycemia. Continue glucose/insulin infusions until the patient is metabolically stable and tolerating solid food. Discontinue insulin/glucose infusions 30 to 60 min after the administration of subcutaneous insulin. Measure BG level before each meal, at 2200, and at 0300. Provide 3 meals and 3 small snacks per day (20 to 30kcal/kg/day). Administer short-acting insulin 30min before each meal. Make sure meals provided at appropriate time interval. Rapid-acting insulin may be given immediately prior to the meal. Dose insulin according to the above schedule. Abbreviation: U, subcutaneous close of short-acting insulin. Source: From Refs. 63,64.

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