dromlakhani GCIH Correctional Insulin Selector
What this skill does
Selects the type and dose of correctional insulin to give simultaneously with the glucocorticoid, to neutralise its glycemic effect. Based on the Lakhani et al. 2017 GCIH protocol (IJEM, DOI: 10.4103/ijem.IJEM_226_17).
Step 1 — Identify the glucocorticoid
Ask: Which glucocorticoid is the patient receiving, and at what dose?
Supported glucocorticoids: Prednisolone, Methylprednisolone, Dexamethasone, Hydrocortisone
If the patient is on a different glucocorticoid (e.g. budesonide, triamcinolone), convert to prednisolone equivalents first.
Step 2 — Select insulin TYPE
| Glucocorticoid | Correctional Insulin Type | Rationale |
|---|---|---|
| Prednisolone | Insulin NPH | NPH peak matches prednisolone's glycemic peak (6–8 h postdose) |
| Methylprednisolone | Insulin NPH | Same glycemic profile as prednisolone |
| Dexamethasone | Insulin Glargine | Dexamethasone's glycemic effect lasts up to 48 h; glargine's long action matches |
| Hydrocortisone | Regular Human Insulin | Hydrocortisone peaks at 2 h; regular insulin peaks at 2 h — perfect match |
Give the correctional insulin at the same time as the glucocorticoid.
Step 3 — Calculate insulin DOSE
Dose is based on glucocorticoid dose and patient weight (kg).
| Prednisolone (mg) | Methylprednisolone (mg) | Dexamethasone (mg) | Hydrocortisone (mg) | Correctional Insulin Dose |
|---|---|---|---|---|
| 10 | 8 | 2 | 50 | 0.1 units/kg |
| 20 | 16 | 4 | 100 | 0.2 units/kg |
| 30 | 24 | 6 | 150 | 0.3 units/kg |
| ≥40 | 32 | 8 | 200 | 0.4 units/kg |
Formula: Dose (units) = units/kg × patient weight in kg
Example: Patient on prednisolone 30 mg, weight 70 kg → 0.3 × 70 = 21 units NPH, given at same time as prednisolone.
Step 4 — Decide whether additional background insulin is needed
This correctional insulin is not a replacement for background basal-bolus insulin in patients with established diabetes.
- Patient has established DM (Group 1): Add correctional insulin ON TOP of background basal-bolus insulin → use the [GCIH Background Insulin Initiator] skill
- Patient developed GCIH without prior DM (Group 2): Correctional insulin alone — no background insulin required initially
Clinical Guardrails
- Do not use this protocol for patients on intravenous insulin infusions, enteral/parenteral nutrition, ICU, or insulin pumps.
- Stop all oral antidiabetics, premixed insulin, and non-insulin injectables before starting.
- If glucocorticoid is given in divided doses (e.g. hydrocortisone 50 mg TDS), apply the correctional dose calculation to each administration.
- For patients >70 years: be conservative — start at the lower end of the dose range.
- Monitor CBG 4× daily: fasting, pre-lunch, pre-dinner, bedtime.
- If a single dose of glucocorticoid or <48 h course: do NOT use this protocol.
Source: Lakhani OJ, Kumar S, Tripathi S, Desai M, Seth C. Comparison of two protocols in the management of glucocorticoid-induced hyperglycemia among hospitalized patients. Indian J Endocr Metab 2017;21:836–44. DOI: 10.4103/ijem.IJEM_226_17