Table 1.
(A–D) Blood Glucose (BG) Measurements and Bolus Protocol Recommended to Reduce Hypoglycemia
| Table 1A below represents the column formats from the original Food and Drug Administration-cleared 100–140 mg/dL protocol and the newly created modified protocols. The subsequent table is recreated identically to the original Yale column format, with the exception of the 75–99 mg/dL column on the far left. There has been no change to the calculations for the recommendations. The only change is the glucose level, which triggers the calculation. | |||||
| Table 1A | |||||
| Original 100–140 | BG 75–99 mg/dL | BG 100–139 mg/dL | BG 140–199 mg/dL | BG ≥200 mg/dL Instructions | |
| 120–140 | BG 75–99 mg/dL | BG 100–119 mg/dL | BG 120–140 mg/dL | BG 141–200 mg/dL | BG >200 mg/dL Instructions |
| 140 | BG 75–99 mg/dL | BG 100–139 mg/dL | BG 140 mg/dL | BG 141–200 mg/dL | BG >200 mg/dL Instructions |
| Table 1B | |||||
| BG ↑ >50 mg/dL/h | BG ↑ | ↑Infusion by “2Δ” (see Table 1C) | |||
| BG ↑ by >25 mg/dL/h | BG ↑1–50 mg/dL/h or BG unchanged | BG unchanged or BG ↓1–25 mg/dL/h | ↑ Infusion by “Δ” (see Table 1C) | ||
| See belowa | BG ↑ | BG ↑ by 1–25 mg/dL/h, BG unchanged, or BG ↓1–25 mg/dL/h | BG ↓ by 1–50 mg/dL/h | BG ↓ by 26–75 mg/dL/h | No infusion change |
| BG unchanged or BG ↓ by 1–25 mg/dL/h | BG ↓26–50 mg/dL/h | BG ↓ by 51–75 mg/dL/h | BG ↓ by 76–100 mg/dL/h | ↓ Infusion by “Δ” (see Table 1C) | |
| BG ↓ by >25 mg/dL/h (see belowa) | BG ↓ by >50 mg/dL/h | BG ↓ by >75 mg/dL/h | BG ↓ by >100 mg/dL/h | Hold insulin infusion. Check BG in 30 min. If greater than lower target, restart infusion at a rate ↓ by “2Δ” (see Table 1C) If BG lower than lower target, see belowa | |
| aD/C Insulin infusion: check BG every 30 min until ≥90 and then every hour; when BG ≥ lower target mg/dL, restart infusion at 75% of most recent rate. | |||||
| Table 1C: Changes in infusion rate (“Δ”) are determined by the current rate | |||||
| Current rate (U/h) | Δ = Rate change (U/h) | 2Δ = 2 × Rate change (U/h) | |||
| <3.0 | 0.5 | 1 | |||
| 3.0–6.0 | 1 | 2 | |||
| 6.5–9.5 | 1.5 | 3 | |||
| 10–14.5 | 2 | 4 | |||
| 15–19.5 | 3 | 6 | |||
| 20–24.5 | 4 | 8 | |||
| ≥25 | ≥5 | 10 (consult MD) | |||
| Table 1D: Bolus protocol | |||||
| BG | BG increase | Bolus | |||
| 141–160 | >20 | Δ | |||
| 161–180 | >20 | 2Δ | |||
| >180 | ≥0 | 2Δ | |||
| When following the paper protocol, users perform a BG measurement and find which column corresponds to the glucose reading. They then would have to calculate the change in glucose reading from the prior glucose reading. Once this is determined, the user chooses the row that corresponds to the glucose reading and the rate/direction of change. The far right column of that row combined with Table 1C is then used to determine the adjustment. Table 1D is the bolus protocol. | |||||