874-P: Use of Weight-Based Insulin to Reduce Hyperglycemia when Transitioning to Subcutaneous Insulin in MICU

Introduction: Hyperglycemia often occurs after transition from intravenous insulin infusion (IVII) to subcutaneous insulin (SCI) in the medical intensive care unit (MICU). We assessed whether addition of weight-based basal (timed with IVII) and bolus insulin (added after) improves glycemic control after transition. Methods: This prospective study included 64 MICU patients on IVII for 24+ hrs. Exclusions were ESRD, T1DM, and active use vasopressors. Intervention arm received weight-based basal insulin (0.2-0.25 units/kg) every day on the IVII after enrollment and weight-based bolus insulin added post IVII. Control arm was current care. Glycemic control up to 48 hours post IVII was compared. Results: Patients had mean age of 59±15 (SD) years, 46% were male, and 78% had prior DM. Higher steroid use in control arm (34% vs.. 12%, p=0.046) but otherwise arms were similar (AKI/CKD, presence DM, illness severity, NPO post IVII). Blood glucose was significantly lower in the intervention arm starting 12 hrs post IVII (Table 1). The intervention arm had similar hypoglycemia frequency ( Conclusion: Starting weight-based basal SCI during and bolus SCI after IVII in the MICU results in better glycemic control post IVII at 12 hrs post and onwards without higher risk of hypoglycemia. This study provides an alternative method by which to improve transitions to SCI in the MICU. Disclosure K. Zhou: None. L. A. Buehler: None. T. Z. Zaw: None. J. F. Bena: None. M. Lansang: Consultant; Self; Sanofi, Research Support; Self; Dexcom, Inc.