11 A

The best method will be an insulin intravenous infusion, with the dose of insulin adjusted hourly in order to keep the plasma glucose between 5 and 10mmol/L. If this is not possible, a subcutaneous sliding scale insulin regimen can be used.

An insulin intravenous infusion regimen and a subcutaneous insulin sliding scale regimen are both used for control of plasma glucose in an acute setting.

An insulin intravenous infusion regimen is absolutely required when controlling blood sugar in a patient who is unable to take orally (example: during surgery or because of vomiting). An insulin sliding scale regimen where multiple doses of short acting insulin is given subcutaneously with frequent glucose monitoring is used for control of blood sugar in acute medical conditions where the patient is able to take orally.

A subcutaneous sliding scale insulin regimen where insulin is given three or four times daily is often used as a substitute for an insulin infusion regimen because an insulin infusion regimen requires intensive monitoring.

In an insulin intravenous infusion regimen, plasma glucose must be monitored every hour while in a subcutaneous sliding scale regimen, it is monitored every 8 hours or every 6 hours.

Plasma glucose control will be better with an insulin intravenous infusion regimen than with a subcutaneous sliding scale regimen.

When using a sliding scale insulin regimen where insulin is given more frequently than every eight hours subcutaneously, it is important to remember that hypoglycemia can occur abruptly because of insulin pharmacokinetics that result in overlap of insulin action.



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