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Hourly Subcutaneous Insulin

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Hourly Subcutaneous Insulin, Hourly Subcutaneous Insulin Aspart, Hourly Subcutaneous Insulin Lispro

  • See Also
  1. Diabetic Ketoacidosis Management in Adults
  2. Diabetic Ketoacidosis Management in Children
  3. Insulin Infusion
  4. Diabetic Ketoacidosis
  5. Insulin
  6. Bolus Insulin
  7. Analog Basal Insulin
  8. Glucose Metabolism
  9. Type II Diabetes Medications
  10. Type 1 Diabetes Mellitus
  • Indications
  1. See Diabetic Ketoacidosis Management in Adults
  2. See Diabetic Ketoacidosis Management in Children
  3. Alternative to Insulin Infusion (Insulin Drip) in Diabetic Ketoacidosis
  • Protocol
  • Adults
  1. See Diabetic Ketoacidosis Management in Adults
  2. General
    1. Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
    2. Coadminister fluids as per Diabetic Ketoacidosis
    3. Discontinue hourly dosing when Glucose 150-200
    4. Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
  3. Hourly SQ Insulin Protocol
    1. Initial SQ bolus dose: 0.3 units/kg (other protocols start with 0.1 unit/kg)
    2. Next: 0.1 units/kg/hour SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
    3. Next: 0.05 units/kg/hour SQ until DKA resolves
  4. Every 2 hour SQ Insulin Protocol
    1. Initial SQ bolus dose: 0.3 units/kg
    2. Next: 0.2 units/kg every 2 hours SQ until Hyperglycemia corrects (Blood Glucose <250 mg/dl)
    3. Next: 0.1 units/kg every 2 hours SQ until DKA resolves
  • Protocol
  • Children
  1. See Diabetic Ketoacidosis Management in Children
  2. Precautions
    1. SQ Insulin for DKA Management is less established in children
  3. General
    1. Use subcutaneous Rapid-Acting Insulin (Lispro, Aspart)
    2. Coadminister fluids as per Diabetic Ketoacidosis
    3. Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
  4. Every 2 hour SQ Insulin Protocol
    1. Give 0.1 to 0.15 units/kg every 1-2 hours
    2. Decrease dosing as Hyperglycemia corrects (Blood Glucose <250 mg/dl)
  • Precautions
  1. Correct Hypokalemia prior to Insulin Dosing
  2. Fluid administration is central to DKA treatment
  • Monitoring
  1. Blood Glucose every 30 minutes to 1 hour
  • Advantage over Insulin Infusion
  1. May be monitored on regular medical ward (non-ICU)
  2. Reduced cost by 39% compared with infusion
  • Safety and efficacy
  1. As effective and safe as Insulin Infusion
  • References
  1. Umpierrez (2004) Am J Med 117:291-6 [PubMed]
  2. Karoli (2011) Indian J Pharmacol 43(4): 398-401 [PubMed]