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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. Insulin Infusion
  2. Diabetic Ketoacidosis
  3. Insulin
  4. Bolus Insulin
  5. Analog Basal Insulin
  6. Glucose Metabolism
  7. Type II Diabetes Medications
  8. Type 1 Diabetes Mellitus
  • Indications
  1. Diabetic Ketoacidosis in Adults
    1. Alternative to Insulin Infusion (Insulin Drip)
  1. General
    1. Coadminister fluids as per Diabetic Ketoacidosis
    2. Discontinue hourly dosing when Glucose 150-200
    3. Monitor serum electolytes, Serum Ketones, and Venous Blood Gas every 4 hours
  2. 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
  3. Every 2 hour SQ Insulin Protocol
    1. Initial SQ bolus dose: 0.3 units/kg
    2. Next: 0.3 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
  • 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]