Lower insulin doses are required with decreased eGFR (titrate to effect).
- Insulin NPH and insulin regular have a higher risk of hypoglycemia because they are human insulin.
- Mixed formulations (i.e., insulin NPH and regular 70/30) have a higher risk of hypoglycemia.
- Consider insulin if A1C ≥10%.
- Educate patients on the importance of a consistent diet while on insulin and the dangers of skipping a meal.
- AGS Beers Criteria: Avoid sliding scale insulin because of a higher risk of hypoglycemia without improvement in hyperglycemia management regardless of care setting.
- Strategies to minimize hypoglycemic risk:
- Patient education
- Frequent self monitoring of blood glucose
- Flexible and rational insulin regimens
- Individualized glycemic goals
- Ongoing monitoring and support