5.2.4.0 Tran­si­tion­ing Intrave­nous to Sub­cu­ta­neous In­sulin

When dis­con­tin­u­ing in­tra­ve­nous in­sulin, a tran­si­tion pro­to­col is as­so­ci­at­ed with less mor­bid­i­ty and lower costs of care (42) and is there­fore rec­om­mend­ed. A pa­tient with type 1 or type 2 di­a­betes being tran­si­tioned to outpa­tient sub­cu­ta­neous in­sulin should re­ceive sub­cu­ta­neous basal in­sulin 2–4 h be­fore the in­tra­ve­nous in­sulin is discon­tin­ued. Con­vert­ing to basal in­sulin at 60–80% of the daily in­fu­sion dose has been shown to be ef­fec­tive (2,42,43). For pa­tients con­tin­u­ing reg­i­mens with con­cen­trat­ed in­sulin (U-200, U-300, or U-500) in the in­pa­tient set­ting, it is im­por­tant to en­sure the cor­rect dos­ing by uti­liz­ing an in­di­vid­u­al pen and car­tridge for each pa­tient, metic­u­lous phar­ma­cist su­per­vi­sion of the dose ad­min­is­tered, or other means (44,45).