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 to match; Tresiba is long-acting and forgiving. Converting twice-daily NPH to a once-daily basal: start at ~80% of the total daily NPH dose.
Oral & non-insulin diabetes medications
| Class (examples) | Inpatient use | Notes |
|---|---|---|
| Biguanide — metformin (Glucophage) | Stop | Risk of lactic acidosis |
| Sulfonylureas — gliclazide (Diamicron), glimepiride (Amaryl) | Avoid | High hypoglycemia risk |
| DPP-4 inhibitors — Januvia, Trajenta, Galvus, Onglyza | Continue if stable | Low risk, safe in eating patients |
| GLP-1 RAs — Ozempic, Victoza, Trulicity | Avoid | Nausea, limited inpatient benefit |
| SGLT2 inhibitors — Forxiga, Jardiance | Avoid | Risk of DKA, dehydration |
| Thiazolidinediones — pioglitazone (Actos) | Avoid | Risk of edema, HF |
| Combinations — Synjardy, Xigduo, Janumet | Per components | Usually hold the SGLT2/metformin part inpatient |
| Alpha-glucosidase inhibitors — acarbose | Not used | Ineffective if NPO |
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 |
A subcutaneous correction scale on top of the patient’s usual regimen. This is a conservative scale for an insulin-sensitive adult: reduce in the frail, elderly, or CKD (hypo risk), and expect higher requirements in insulin-resistant patients (obesity, high-dose steroids, large home insulin doses). Titrate to the individual. For DKA/HHS or the nil-by-mouth patient, use an 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 current local policy, the formulary, and renal/hepatic function before prescribing. Last reviewed: July 2026.
Last reviewed · July 2026