Endocrinology Book

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Variable Rate Insulin InfusionAka: Insulin Infusion, Insulin Drip

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  1. See Also
    1. Hourly Subcutaneous Insulin Lispro
  2. Indications
    1. Patient not eating (e.g. post-operative)
  3. Preparation
    1. Regular Insulin 100 units in 100 cc NS (1 u per 1 ml)
  4. Protocol for Insulin Infusion
    1. Starting dose of Insulin infusion
      1. Type I Diabetic: 0.5 to 1 unit per hour
      2. Type II Diabetic or poor control: 2-3 units per hour
      3. Weight-based: 0.05 Units/kg/h (0.1 Units/kg/h in DKA)
    2. Coadminister D5W at 100 to 125 cc per hour
    3. Check Blood Glucose every 30 minutes to 1 hour
      1. Glucose <70 Then
        1. Turn off Insulin drip for 30 minutes
        2. Blood Glucose on recheck still <70
          1. Give 25 ml of D50 IV (or 10-12 grams glucose)
        3. Recheck Blood Glucose every 30 minutes
          1. Restart infusion when glucose >100 mg/dl
          2. Decrease Insulin drip rate by 1.0 u/h
      2. Glucose 71-120 Then
        1. Decrease Insulin drip by 1.0 u/hour
      3. Glucose 121-180 Then
        1. No change
      4. Glucose 181-250 Then
        1. Increase Insulin drip by 2 units/hour
      5. Glucose 251-300 Then
        1. Increase Insulin drip by 3 units/hour
      6. Glucose 301-350 Then
        1. Increase Insulin drip by 4 units/hour
      7. Glucose 351-400 Then
        1. Increase Insulin drip by 5 units/hour
      8. Glucose >400 Then
        1. Increase Insulin drip by 6 units/hour
    4. IF Insulin drip drops to 0 units/hour
      1. Continue q2 hour Blood Glucose Monitoring
      2. Restart Insulin drip when Blood Glucose >150
  5. Discontinuation (e.g. Postoperatively)
    1. Administer patient's usual Insulin dose pre-meal
    2. Patient eats meal
    3. Discontinue Insulin infusion two hours after meal
  6. References
    1. Marks (2003) Am Fam Physician 67(1):93

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