Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK
GLUCOSE MONITORING
- Target glucose 6.0 -10.0 mmol/L (up to 12.0 mmol/L is acceptable)
Frequency of monitoring
- People not known to have diabetes
- Check the glucose at least 6 hourly ideally at fasting periods (e.g. before meals and at bedtime).
- People with diabetes
- Check fasting glucose at least 6 hourly, or more frequently if the glucose is outside the 6.0 -10.0 mmol/L range
ADVICE FOR CORRECTING INITIAL HYPERGLYCAEMIA – GLUCOSE ABOVE 12.0 MMOL/L
- Exclude DKA/HHS
- Use subcutaneous rapid acting insulin analogue (Novorapid®/Humalog®/Apridra®) as described below. Note these are conservative doses and depending on response in individual patients, as previously stated, may need to be increased rapidly (or where more insulin sensitive, decreased)
- Recheck glucose at 4 hrs to determine response and whether a further correction dose is needed
Insulin naïve
Follow the weight-based tables below in those people:
- Not known to have diabetes
- Type 2 diabetes treated with diet alone or with oral hypoglycaemic agents
Insulin treated
Where the total daily dose (TDD) of insulin is known follow the guidance in the table based on TDD. If the TDD is unknown, follow guidance according to the person’s weight
CORRECTION DOSES OF RAPID ACTING INSULIN
