a. When a diabetic is hospitalized, the combination of illness, stress, and change in routine may cause an insulin imbalance.

Therefore, the patient will normally have routine urine (or blood) testing for sugar and acetone. If sugar is “spilled” into the urine, additional insulin (“insulin coverage”) is given in addition to the patient’s regular dose.

b. This coverage is commonly ordered on a “sliding scale.” That is, the physician will order additional insulin in correlation with the amount of sugar present in the urine. For example:

no sugar = no insulin,

1+ sugar = 5 units regular insulin

2+ sugar = 10 units regular insulin

3+ = 15 units regular insulin

4+ = 20 units regular insulin

As you see, the additional coverage is increased as the amount of sugar in the urine increases.