The question requires calculating the subcutaneous insulin regimen based on the patient's recent intravenous (IV) insulin requirement and the physician's suggested ratio. The patient's average total daily dose (TDD) from the IV insulin drip was 70 units. The suggested split is 70% for long-acting (basal) insulin and 30% for short-acting (bolus) insulin.

1. Calculate Basal Dose (Insulin Glargine):

TDD × Basal Percentage = 70 units × 0.70 = 49 units.

2. Calculate Total Bolus Dose (Insulin Lispro):

TDD × Bolus Percentage = 70 units × 0.30 = 21 units.

3. Calculate Per-Meal Bolus Dose:

Total Bolus Dose / Number of meals = 21 units / 3 meals = 7 units per meal.

This calculation results in a regimen of 49 units of Insulin Glargine daily and 7 units of Insulin Lispro three times a day with meals.

B. This option represents a 36:64 basal-to-bolus ratio (25 units / 70 units ≈ 36%), which is incorrect.

C. This option represents a 57:43 basal-to-bolus ratio (40 units / 70 units ≈ 57%), which is incorrect.

D. This option represents a 66:34 basal-to-bolus ratio (46 units / 70 units ≈ 66%), which is incorrect.

E. This option represents a 74:26 basal-to-bolus ratio (52 units / 70 units ≈ 74%), which is incorrect.

1. American Diabetes Association Professional Practice Committee. (2023). 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2023. Diabetes Care

46(Supplement1)

S247–S257. https://doi.org/10.2337/dc23-S015. (Section: "Transitioning From Intravenous to Subcutaneous Insulin

" which discusses basing the initial subcutaneous dose on the IV infusion rate over the preceding hours).

2. UCSF Division of Hospital Medicine. (2023). Hyperglycemia & Diabetes. In The UCSF Hospitalist Handbook. University of California

San Francisco. Retrieved from https://hospitalmedicine.ucsf.edu/manual/ch15hyper.html. (Chapter: "Transitioning from Insulin Drip to Subcutaneous Insulin

" which outlines the method of calculating the TDD from the 24-hour IV requirement and then splitting it into basal and bolus components).

3. Kitabchi

A. E.

Umpierrez

G. E.

Miles

J. M.

& Fisher

J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care

32(7)

1335–1343. https://doi.org/10.2337/dc09-9032. (Section: "Transition to Subcutaneous Insulin

" which describes the general principles for initiating a multiple daily injection regimen after DKA resolution).