I am Consultant Endocrinologist & Diabetologist and have delivered many lectures on insulin (inpatient and outpatient), but I must acknowledge that this was one of the best and simplest approach to inpatient diabetes management. Really well done 👏
Thanks for the video. It clarified isf and cho. But please reply to explain the transition from insulin drip to basal/bolus regimen.essentially the last 5minutes. Thanks. From a peripheral hospital in nigeria. Dr Uzoma.
From my understanding, if someone comes in with sky high glucose, it seems they start by giving one unit insulin (probably short acting ?) and then incrementally increasing by 0.1 unit every one-two hours (I'm not sure about the exact timing) until they see the glucose coming down to a target range of 140-180. Now let's say they achieved this decrease by 1.4 units of insulin and they were able to maintain the glucose in the 140-180 range by just giving 1.4 units of insulin for the next 5hrs. This tells you that this patient that is fasting, requires 1.4 units of insulin per hour which translates to 1.4*24h= 33.6 units per 24 hr which is your basal rate. Now since basal rate is half of TDD you can see that TDD would be 33.6*2=67.2 and then from there you can calculate the CHO which is 500/67.2=7.4 (1 unit of insulin bolus for every 7.4g of carbs) and ISF is 1800/67.2= 26.8. So in this pt 1 unit of insulin dec glucose by 26.8. If this pt was 60kg her ideal ISF would be 60. So this means that the pt with ISF of 26.8 is more resistant to insulin and will require more.
