For inpatient hyperglycemia management and insulin drip protocols, see inpatient hyperglycemia.
Insulin
| Type | Generic | Brand | Typical use | Onset | Peak | Duration |
|---|---|---|---|---|---|---|
| Rapid-acting | Insulin aspart | NovoRapid | Pre-meal bolus | 10–20 min | 1–3 h | 3–5 h |
| Rapid-acting | Insulin lispro | Humalog | Pre-meal bolus | 15–30 min | 1–2 h | 4–5 h |
| Short-acting | Regular insulin | Actrapid | Correction / pre-meal / IV drip | 30 min | 2–4 h | 6–8 h |
| Intermediate | NPH insulin | Insulatard / Humulin N | BID basal | 60–90 min | 4–6 h | 12–18 h |
| Basal | Insulin glargine | Lantus | OD basal | 60–120 min | No peak | ~24 h |
| Basal (ultra-long) | Insulin glargine U300 | Toujeo | Long-acting basal | 60–120 min | No peak | > 24 h |
| Basal (ultra-long) | Insulin degludec | Tresiba | Ultra-long basal | ~1 h | No peak | ~42 h |
| IV insulin | Regular insulin (IV) | Humulin R | DKA, ICU insulin drip | Immediate | Varies | Short |
| Premixed | Biphasic insulin aspart | NovoMix 30 | Premixed (basal + bolus) | 10–20 min | 1–4 h | Up to 24 h |
| Premixed | Biphasic human insulin 30/70 | Mixtard 30 | Premixed, commonly used | 30 min | 2–8 h | Up to 24 h |
Switching basal insulin (Lantus ↔ Toujeo ↔ Tresiba): start at ~1:1 total daily units and titrate; Toujeo (U300) often needs ~10–15% more; Tresiba is long-acting and forgiving. Twice-daily NPH to once-daily basal: start at ~80% of the total daily NPH dose.
Oral & non-insulin diabetes medications
| Class (examples) | Continue / hold | Restart when |
|---|---|---|
| Biguanide: metformin (Glucophage) | Hold for contrast, procedures, acute illness, or declining renal function (lactic acidosis risk) | Eating, stable, renal function acceptable |
| Sulfonylureas: gliclazide (Diamicron), glimepiride (Amaryl) | Hold if NPO or intake unpredictable (hypoglycemia risk) | Once eating reliably |
| DPP-4 inhibitors: Januvia, Trajenta, Galvus, Onglyza | Continue if eating and stable (low hypoglycemia risk) | – |
| GLP-1 RAs: Ozempic, Victoza, Trulicity | Hold if acutely ill or NPO (limited inpatient data). Perioperative hold is individualised | Stable and eating |
| SGLT2 inhibitors: Forxiga, Jardiance | Continue or initiate for HF if no contraindication (ADA 2026, grade A). Hold for severe illness, ketonemia/ketonuria, fasting, or surgery: stop 3 days pre-op (4 for ertugliflozin). Watch for euglycemic DKA. Not for glycemic control alone inpatient | Eating, stable, HF indication still applies |
| Thiazolidinediones: pioglitazone (Actos) | Hold (fluid retention / HF risk) | Outpatient, once stable |
| Combinations: Synjardy, Xigduo, Janumet | By component: hold SGLT2i / metformin per above | Per component |
| Alpha-glucosidase inhibitors: acarbose | Hold if NPO (ineffective without oral intake) | Once eating |
Correction (sliding) scale
| Capillary glucose | Rapid-acting insulin SC |
|---|---|
| 10–14 mmol/L | 2 units |
| 14–17 mmol/L | 4 units |
| 17–20 mmol/L | 6 units |
| > 20 mmol/L | 8 units + check ketones, call senior |
Subcutaneous correction scale on top of the usual regimen; a conservative scale for an insulin-sensitive adult. Reduce in frail, elderly, or CKD (hypo risk); expect higher needs with insulin resistance (obesity, high-dose steroids, large home doses); titrate to the individual. DKA/HHS or nil by mouth: IV variable-rate insulin infusion (VRIII) per local protocol, not this SC scale.
Educational reference for clinicians. Doses are typical adult starting points. Cross-check allergies, interactions, current local policy, the formulary, and renal/hepatic function before prescribing.
Last updated · September 2026