Prescription:

  • NEVER use abbreviations e.g. ‘U’ OR ‘IU’
  • PRESCRIBE rapid acting, short acting, human biphasic and analogue biphasic insulins with meals
  • ALWAYS PRESCRIBE BASAL or INTERMEDIATE acting insulin to patients with type 1 DM

•ALWAYS use the FULL CORRECT and proprietary name of the insulin

•ENSURE prescription is SIGNED and DATED

•AVOIDPRN insulin. If clinically required, prescribe STAT dose of rapid-acting insulin and review regular insulin doses

•PRESCRIBE and REVIEW insulin doses on a regular basis according to clinical need

•CROSSoff and re-write the prescription if changes are required

•IF changes in the patient’s insulin regimen are required, as a general rule, alter one insulin prescription at a time by 10%-20% of the dose

•FURTHER dose adjustments should be made no less than 48 hourly

Administration:

  • ALL insulin doses must be measured and administered using either an insulin syringe or a commercial pen device
  • NEVER draw up insulin from a prefilled pen device or cartridge
  • ALWAYSgive rapid acting,short acting, human biphasic and analogue biphasic insulins with meals
  • PATIENTS self-administering insulins should be assessed daily and this should be documented accordingly
  • ALWAYS administer BASAL or INTERMEDIATE acting insulin to patients with type 1 DM
  • INSULIN devices in use must be stored in the patient’s bedside locker and most have a 4-week expiry from the date firstused
  • INSULIN devices NOT in use should be stored in the ward fridge. The expiry date for unused insulin willbe the manufacturers
  • CONFIRM any single dose of BASAL or INTEMEDIATE acting insulin over 50 units and any dose over 25 units of rapid or short acting insulin and document
  • INSULIN doses must never be omitted or delayed unless clearly outlined on the prescription and documented in the medical notes by the prescriber
  • ALWAYS use insulin safety needles when administering insulin using pen devices
  • PATIENTS who self-administers their insulin using pen devices should be using ordinary pen needles
  • ALWAYS inspect for lipohypertrophy (fat lumps) and avoid these sites
  • ALWAYS rotate injection sites

Prescription:

  • NEVER use abbreviations e.g. ‘U’ OR ‘IU’
  • ALWAYS use the appropriate intravenous prescription chart according to the clinical need
  • ONLY PRESCRIBE intravenous insulin regime if clinically indicated. DO NOT USE in the management of HYPOGLYCAEMIA
  • ALWAYS PRESCRIBE BASAL or INTERMEDIATE acting insulin specially to patients with type 1 DM even whilst on intravenous insulin

•ALWAYS PRESCRIBE the appropriate intravenous fluid for hydration and/or substrate

•THINK POTASSIUM! Review regularly and replace as required

•ENSURE prescription is SIGNED and DATED

•PRESCRIBE and REVIEW intravenousinsulin infusion algorithm/rate on a regular basis according to clinical need

•CROSS off and re-write the intravenousinsulin infusion algorithm/rate prescription if changes are required

•MONITOR other parameters i.e. blood gases, U & E’s etc. as required and as appropriate

•IF hypoglycaemia occurs whilst on intravenous insulin infusion, STOP, CHECK CBG after 10-15 minutes and RESTART infusion using a slower algorithm/rate if CBG >4 mmol/L

•MAINTAIN IV insulin infusion for 30 minutes after re-starting original subcutaneous insulin regime- IV insulin has a 5 minute half-life

Administration:

  • NEVER draw up insulin from a prefilled pen device or cartridge
  • NEVER use an IV syringe to draw up insulin
  • ALWAYS draw up insulin using an insulin syringe
  • ALWAYS administer BASAL or INTERMEDIATE acting insulin specially to patients with type 1 DM even whilst on intravenous insulin
  • ALWAYS ensure the infusion ofthe appropriate intravenous fluid for hydration and/or substrate
  • THINK POTASSIUM! Review regularly and replace as prescribed
  • MONITOR CBG(and blood ketones if required)hourly and adjust intravenous insulin infusion rate accordingly. ALWAYS sign all entries
  • IF hypoglycaemia occurs whilst on intravenous insulin infusion, STOP, CHECK CBG after 10-15 minutes and RESTART infusion using a slower algorithm/rate if CBG >4 mmol/L. ENSURE changes are discussed with the medical team and prescribed accordingly
  • MAINTAIN IV insulin infusion for 30 minutes after re-starting original subcutaneous insulin regime- IV insulin has a 5 minute half-life