Insulin

Even though the protocol for dosing insulin can be carefully calculated for the particular patient in need, what if that patient’s need for insulin changes quickly after the initial dose recommendation? This concept is not only unheard of, it is very common. Based on a wide range of factors, such as a patient’s activity level, meals consumed, and stress, a patient’s insulin may change. In this case, the dosing of insulin needs to reflect that change.

A computerized glucose management system (CGM) not only enhances the ease of use and accuracy, but one in particular has the artificial intelligence which cannot be found in linear or sliding scale protocols and lookup tables. You may find yourself asking, ‘what is different from one CGM to the next?’ Many computerized glucose management systems rely on the same protocols as manual methods, often imprecise and falling short of achieving optimal glycemic control.

One of the main factors affecting insulin dosing is estimated residual extracellular insulin (EREI). EREI refers to residual insulin in the patient’s body from a previous method of insulin therapy. This remaining insulin continues to stay in the blood stream, affecting future blood sugar levels. Without taking EREI into consideration, excess insulin builds up and results in insufficient blood sugar levels, or worse, the occurrence of hypoglycemia.

To effectively manage glucose care, hospitals should not only use CGMs, but ensure those CGMs are individualized for the patient. When evaluating different CGMs, be sure your hospital chooses a CGM that takes computerized insulin dosing a step beyond traditional management by incorporating an EREI calculation. This calculation needs to take the patient’s unique physiology into account and estimate how much insulin remains in the patient’s body from a prior dose, before calculating the following dose.

Make sure your computerized glucose management tool is more than just a computer. Just because a dose of insulin is showing on a computer screen, doesn’t mean it is any different from the paper protocol.