A dose-defining insulin algorithm for attainment and maintenance of glycemic targets during therapy of hyperglycemic crises

Target Attainment Through Algorithm Design During Intravenous Insulin Infusion

“…For readings below target, these algorithms may require dextrose infusion and/or temporary interruption the infusion. 23 This report from Saint Francis Hospital of the performance of algorithms having three different target ranges 5,6 represents a milestone in the development from predecessor paper tabular algorithms, having similar format but different target ranges. 7,[24][25][26][27] The long-range goal is to achieve full computerization.…”

“…The algorithms as previously published display IRs in tabular form in which columns correspond to MR values and rows correspond to BG ranges, with user discretion to modify the starting column, which otherwise is assigned by default, and with columnchange rules executed by nursing staff, based on rate of change of BG and previous column assignment. [5][6][7] The computerizable mathematical design (Tables 1 and 2) and the effects of translation to paper algorithms (Table 3) are shown in Figure 1. The prescriber selects the HHS or DKA algorithms from an order set for hyperglycemic crises, which states biochemical criteria suggestive of the diagnosis of the respective syndromes, adapted from published guidelines.…”

“…The prescriber selects the HHS or DKA algorithms from an order set for hyperglycemic crises, which states biochemical criteria suggestive of the diagnosis of the respective syndromes, adapted from published guidelines. 1,6 A modification subsequent to the published description of the standard default algorithm, potentially affecting some treatment courses during the interval of data collection, specifies column down-titration in case of BG < 100 mg/dL, as shown in Tables 1 and 3.…”

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

“…An initially fixed-dose weight-based method for assigning insulin infusion rate during the initial hours of treatment is advocated in the consensus statement of the American Diabetes Association for use during the first several hours of treatment of DKA (Kitabchi et al, 2009). In contrast, a dynamic rule to assign the insulin infusion rate during treatment of hyperglycemic crisis is employed at our institutions (Devi et al, 2011). The deactivation time for intravenous insulin infusion may be as long as 90 minutes (Mudaliar et al, 2008).…”

A Quadruply‐Asymmetric Sigmoid to Describe the Insulin‐Glucose Relationship during Intravenous Insulin Infusion

“…A sigmoidal relationship between IR and BG may help achieve these goals. A prototype for the present work, developed as a set of three tabular algorithms, each having a different target range but created from a single mathematical design, has been implemented in clinical practice [23][24][25]. The specific objective of this paper is to address an essential step necessary to computerization.…”