Last Modified: 3:10pm 18/03/2021

Insulin Excess or change in sensitivity to insulin

• Strict glycaemic control (Hba1c under 48mmol/mol)
• STAT or ‘PRN’ rapid or fast acting insulin administered without food
• Incorrect insulin or oral hypoglycaemic therapy (especially Sulphonylureas) prescribed and/or administered, intramuscular injection (e.g sulphonylurea taken without food)
• Inadequate mixing of intermediate acting or mixed insulins
• Patient with known or suspected malabsorption secondary to exocrine pancreatic insufficiency not on creon (unable to absorb glucose, (measure faecal elastase) or missed creon
• Diarrhoeal illness (food malabsorption)
• Coeliac disease (measure TTG if not known) or exocrine pancreatic insufficiency (reduced glucose absorption)
• Wrongly timed diabetes medication for meal/enteral feed (shortage of glucose as substrate for insulin)
• Use of IV insulin infusion without glucose based infusion fluid (no glucose substrate for insulin)
• Use of IV insulin infusion without appropriate BGM
• Renal failure (reduced insulin clearance or sulphonylurea clearance)
• Severe hepatic dysfunction (reduced hepatic glucose stores)
• Major limb amputation or severe cachexia (reduced muscle mass, weight loss = increased insulin sensitivity)
• Post bariatric or colonic resection surgery
• Recovery and increased mobilisation after acute illness (reduced stress hormone effect on hyperglycaemia with recovery), increased physical activity
• Regular insulin doses or oral hypoglycaemic therapy being administered when not taken routinely at home
• Undiagnosed endocrine disease (thyroid, pituitary disease, hypoadrenalism)
• Increased environmental temperature (more rapid insulin absorption)
• Reduction in steroids without concurrent reduction in diabetes therapies