Table 6.

Outpatient Management Protocol

Monitoring Schedule
DailyIntermittent (2 times/month)
Blood testingBefore breakfastMiddle of the night
Before lunchMidmorning
Before dinnerAfter school
Before bedtime
Urine testingBefore breakfast
Each void when ill
Insulin Regimens
   Start with distribution of:
      2/3 total dose before breakfast
      1/3 total dose in pm
   Morning dose:
      1/3 short-acting or rapid-acting
      2/3 intermediate-acting
   Evening dose:
      1/2 short-acting or rapid-acting
      1/2 intermediate-acting
            —either as one injection with both short- or rapid-acting and intermediate-acting before dinner OR short- or rapid-acting before dinner and intermediate-acting at bedtime
   Alternate regimens:
      Long-acting 1 to 2 times per day
      Short- or rapid-acting with meals
      Continuous insulin infusion via external open-loop pump
Adjustment Algorithms
Immediate Correction of Abnormal Blood Glucose Level Out of Target (70 to 150 mg/dL)
Add extra insulin for each 50 mg/dL above target:eg
<5 years old, 0.25 U for each 50 mg/dL:70–150 Base Dose
Grade school age, 0.5–1 U:150–200 Add 0.5 U
Adolescents, 1–2 U:200–250 Add 0.5 U
Correction of Abnormal Established Pattern
   Short/rapid- or intermediate-acting insulin adjusted after 3-day pattern established
   Increase or decrease by 0.5, 1, or 2 U (10% of dose)
Time of Abnormal TestChange this Insulin
Before breakfastEvening intermediate
Before lunchMorning short/rapid
Before dinnerMorning intermediate
Before bedtimeEvening short/rapid