Prandial Insulin Dosing in Hospitalized Patients

Inclusion Criteria: * general medical or minor surgical hospitalized patients * type 2 diabetes * blood glucose 150-400 on at least 2 occasions within 24 hours or requiring at least 20 units of insulin/day in the 24 hours prior to enrollment Exclusion Criteria: * • Major surgery, occurring within the previous 2 weeks or planned within 72 hours of study entry, including cardiothoracic, neurosurgical, and open intra-abdominal procedures (in particular, any surgery lasting over 2 hours). * Patients receiving glucocorticoids, total parental nutrition (TPN), or tube feeds. * Pregnancy (glucose targets differ in pregnancy). Premenopausal women not on pharmacologic contraceptives, inrauterine device (IUD), or surgical menopause will undergo pregnancy testing. * Patients currently on IV insulin (must wait to enroll) or with planned surgical procedures in the next 72 hours for whom intravenous insulin will be likely * Prolonged (\>24 hour) strict nil per os (NPO-nothing by mouth) status (eg. small bowl obstruction). Liquid or modified consistency diets are acceptable. * Patients for whom expected length of stay will be less than 48 hours * Patients using subcutaneous insulin pumps * Diabetic ketoacidosis * End-stage renal disease on dialysis * End-stage liver disease with cirrhosis * Mental conditions precluding informed consent * Potentially sensitive admissions: prisoners, HIV, suicidality * Unable to give consent in English