Insulin Infusion Protocol

Doctor’s Orders

INSULIN (Regular) INFUSION PROTOCOL
Mixed as standard concentration (100 units in 100mL 0.9%NaCL)
Priming: Flush 50 ml of infusion through all IV tubing before infusion begins
(to saturate the insulin binding sites in the tubing)
May be infused through central line or peripheral IV
Use of this scale is based on HOURLY Blood Glucose (BG) Monitoring. If monitoring > than hourly, refer to calculating of drip in “Changing the Insulin Infusion Rate” section below. Target blood glucose range 120-180 mg/dL
Blood glucose (BG) samples may be obtained through indwelling vascular device or by finger stick.
Initiating the Insulin Infusion / Physicians are determining the starting rate of insulin infusions. Refer to the order in Care Organizer for the specific rate to begin the insulin infusion.Round to the nearest 0.5 unit for the initial infusion rate.
Blood Glucose (BG) Monitoring /
  1. Check BG hourly until stable (defined as 3 consecutive values within target range), with adjustment of infusion rate as indicated)
  2. Once stable, change BG monitoring to every 2 hours, with adjustment of infusion rate as indicated.
  3. Once stable with every 2 hour BG checks for 12 to 24 hours, change monitoring to every 4 hours, with adjustment of infusion rate as indicated, only if:
  • No significant changes in clinical condition, AND
  • No significant change in nutritional intake.
  1. Check BG more frequently, as indicated, for all BG </= 70mg/dL.
  2. If any of the following occur, resume hourly BG monitoring until BG is again stable
(3 consecutive BG values within target range):
  • Any significant change in insulin infusion rate (i.e. BG out of target range)
  • Significant changes in clinical condition
  • Initiation or cessation of pressor or steroid therapy
  • Initiation or cessation of renal replacement therapy (hemodialysis, CVVHD, etc.)
  • Initiation, cessation or rate change of nutritional support (TPN, tube feeds, etc.)

Changing the Insulin Infusion Rate / Note: Follow the treatment across from the blood glucose result range
BG <120 mg/dl STOP INSULIN INFUSION
  1. First calculate the change in the BG per hour (Current BG subtracted from previous BG then divided by hour(s), depending upon when the last blood glucose was taken.) Example: BG at 2PM is 150 mg/dL and it is now 4PM with BG 120 mg/dL. (150-120=30mg/dL difference divided by 2 hours equals a 15 mg/dL/hr decrease.
  2. Take the calculation to determine which column (2, 3 or 4) to follow based on the current BG.
  3. When calculating a rate change, round to the nearest 0.5 unit.
Example: Round 4.78 to nearest 0.5 unit = 5 units/hr
Round 2.35 to nearest 0.5 unit = 2.5 units/hr
Column 2 OR / Column 3 / Column 4
Current Blood Glucose (CBG / If CBG decreased by <50 mg/dl/hr or it is higher than previous CBG check then: / If CBG decreases by 50-70 mg/dl/hr then: / If CBG decreases by >70 mg/dl/hr then:
>250 / Increase infusion rate by 50% (1.5 x current rate) / No Change / No Change
181-250 / Increase infusion rate by 25% (1.25 x rate) / Decrease infusion rate by 10%
(0.9 x rate) / Decrease infusion rate by 20% (0.8 x rate)
120-180 / No Change / No Change / Decrease infusion rate by 25% (0.75 x rate)
<120 / STOP infusion / STOP infusion / STOP infusion
If infusion has been stopped and BG >180 mg/dl, restart infusion at 50% (0.5 x rate) of previous rate
and recheck BG in 60 minutes

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