Endo Correctional Insulin Over Scheduled No Prior Diabetes

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name: endo-correctional-insulin-over-scheduled-no-prior-diabetes
description: Recommends initiating correctional insulin alone for hospitalized adults without prior diabetes who develop hyperglycemia (blood glucose >140 mg/dL). If hyperglycemia persists (≥2 point‑of‑care glucose values ≥180 mg/dL within 24 hours while on correctional insulin), add scheduled basal‑bolus insulin.
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# Initial correctional insulin over scheduled insulin for hyperglycemia without prior diabetes; add scheduled if persistent

## STEP 1 — Gather Information
Collect admission blood glucose, history of diabetes (including type 1, type 2, or none), current medications, and point‑of‑care glucose trends. Confirm no prior diabetes diagnosis and inpatient hyperglycemia (BG >140 mg/dL).

## STEP 2 — Rule In / Rule Out
**Rule in:** No prior diabetes mellitus AND admission or random glucose >140 mg/dL.  
**Rule out:** Known diabetes (type 1 or type 2) OR glucose ≤140 mg/dL without hyperglycemia.

## STEP 3 — Classify or Stratify
After initiating correctional insulin, evaluate point‑of‑care glucose over the next 24 hours:  
- **Persistent hyperglycemia:** ≥2 readings ≥180 mg/dL.  
- **Non‑persistent:** Fewer than 2 readings ≥180 mg/dL or all <180 mg/dL.

## STEP 4 — Decide
If persistent hyperglycemia, add scheduled basal‑bolus insulin (e.g., basal insulin once or twice daily plus prandial correctional insulin) to maintain glucose 100‑180 mg/dL. If not persistent, continue correctional insulin alone and reassess glucose every 6‑12 hours.

## Clinical Guardrails / Mimics / Pitfalls
Do not initiate scheduled insulin as first‑line in patients without prior diabetes; avoid relying solely on sliding scale if hyperglycemia persists; monitor for hypoglycemia when adding scheduled insulin; consider new‑onset type 1 diabetes (check for ketosis, weight loss) and treat accordingly; do not ignore persistent hyperglycemia as it increases infection risk and length of stay.

## Concrete Clinical Example
A 58‑year‑old admitted for community‑acquired pneumonia has no known diabetes. Admission glucose is 152 mg/dL. Correctional insulin sliding scale is started. Over the next 24 hours, two point‑of‑care glucose values are 192 mg/dL and 205 mg/dL. Because hyperglycemia persists, basal insulin glargine 0.1 units/kg is added at bedtime while continuation of correctional insulin before meals.

**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non‑Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278

> **TODO:** consider adding scripts/calc.py for the endo-correctional-insulin-over-scheduled-no-prior-diabetes calculator