Pharm
Variable Rate Insulin Infusion
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Variable Rate Insulin Infusion
, Insulin Infusion, Insulin Drip
See Also
Hourly Subcutaneous Insulin Lispro
Indications
Patient not eating (e.g. post-operative)
Preparation
Regular Insulin
100 units in 100 cc NS (1 u per 1 ml)
Protocol
Insulin Infusion
Starting dose of Insulin Infusion
Type I Diabetic: 0.5 to 1 unit per hour
Type II Diabetic or poor control: 2-3 units per hour
Weight-based (use true weight, not
Ideal Weight
)
Diabetic Ketoacidosis
: 0.1 Units/kg/h
Non-ketotic: 0.05 Units/kg/h
Consider starting with this dose in very large patients with high calculated doses
Insulin
bolus prior to starting Insulin Drip is controversial
Not recommended in pediatric patients
Use in adult
Diabetic Ketoacidosis
does not offer additional benefit over Insulin Infusion alone
Goval (2010) J Emerg Med 38(4): 422-7 [PubMed]
Insulin
bolus dosing in
Diabetic Ketoacidosis
if used (adults only)
Bolus Insulin
dose: 10 units
Coadminister D5W at 100 to 125 cc per hour
Check
Blood Glucose
every 30 minutes to 1 hour
Glucose
<70 Then
Turn off Insulin Drip for 30 minutes
Blood Glucose
on recheck still <70
Give 25 ml of D50 IV (or 10-12 grams
Glucose
)
Recheck
Blood Glucose
every 30 minutes
Restart infusion when
Glucose
>100 mg/dl
Decrease Insulin Drip rate by 1.0 u/h
Glucose
71-120 Then
Decrease Insulin Drip by 1.0 u/hour
Glucose
121-180 Then
No change
Glucose
181-250 Then
Increase Insulin Drip by 2 units/hour
Glucose
251-300 Then
Increase Insulin Drip by 3 units/hour
Glucose
301-350 Then
Increase Insulin Drip by 4 units/hour
Glucose
351-400 Then
Increase Insulin Drip by 5 units/hour
Glucose
>400 Then
Increase Insulin Drip by 6 units/hour
IF Insulin Drip drops to 0 units/hour
Continue q2 hour
Blood Glucose Monitoring
Restart Insulin Drip when
Blood Glucose
>150
Discontinuation (e.g. Postoperatively)
Administer patient's usual
Insulin
dose pre-meal
Patient eats meal
Discontinue Insulin Infusion two hours after meal
References
Marks (2003) Am Fam Physician 67(1):93-100 [PubMed]
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