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    Yale Insulin Infusion Protocol

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    IffatNaeem
    This document provides guidelines for an insulin infusion protocol intended for hyperglycemic adult patients in an ICU setting. It outlines procedures for initiating and titrating an insulin infusion based on blood glucose levels, including priming the IV tubing, target blood glucose range, calculating initial infusion rates and bolus doses, monitoring blood glucose levels, and adjusting the infusion rate up or down based on changes in blood glucose. Safety measures are described such as consulting a physician for blood glucose over 500 mg/dL or in cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome.

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    Yale Insulin Infusion Protocol

    Uploaded by

    IffatNaeem
    2K views2 pages
    This document provides guidelines for an insulin infusion protocol intended for hyperglycemic adult patients in an ICU setting. It outlines procedures for initiating and titrating an insulin infusion based on blood glucose levels, including priming the IV tubing, target blood glucose range, calculating initial infusion rates and bolus doses, monitoring blood glucose levels, and adjusting the infusion rate up or down based on changes in blood glucose. Safety measures are described such as consulting a physician for blood glucose over 500 mg/dL or in cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome.

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    This document provides guidelines for an insulin infusion protocol intended for hyperglycemic adult patients in an ICU setting. It outlines procedures for initiating and titrating an insulin infusion based on blood glucose levels, including priming the IV tubing, target blood glucose range, calculating initial infusion rates and bolus doses, monitoring blood glucose levels, and adjusting the infusion rate up or down based on changes in blood glucose. Safety measures are described such as consulting a physician for blood glucose over 500 mg/dL or in cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2K views2 pages

    Yale Insulin Infusion Protocol

    Uploaded by

    IffatNaeem
    This document provides guidelines for an insulin infusion protocol intended for hyperglycemic adult patients in an ICU setting. It outlines procedures for initiating and titrating an insulin infusion based on blood glucose levels, including priming the IV tubing, target blood glucose range, calculating initial infusion rates and bolus doses, monitoring blood glucose levels, and adjusting the infusion rate up or down based on changes in blood glucose. Safety measures are described such as consulting a physician for blood glucose over 500 mg/dL or in cases of diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    The following insulin infusion protocol is intended for use in hyperglycemic adult patients in an ICU seing, but

    is notspecically tailored for those individuals with diabetic emergencies, such as diabetic ketoacidosis (DKA) or
    hyperglycemichyperosmolar syndrome (HHS). When these diagnoses are being considered, or if BG > 500 mg/dL,
    an MD should be con-sulted for specic orders. Also, notify the responsible physician immediately if the response
    to the insulin infusion isunusual or unexpected, or if any situation arises that is not adequately addressed by
    these guidelines. Any patient on aninsulin infusion should have frequent measurement of serum electrolyte
    concentrations, especially potassium.
    YALE INSULIN INFUSION PROTOCOL
    Adapted from Goldberg PA, et al.
    29
    (Endocrine Practice. July/August 2006.)
    Initiating the Insulin Infusion
    1.) INSULIN INFUSION: Mix 1 unit Regular Human Insulin per 1 mL 0.9% NaCl. Administer via infusion pump
    (in increments of 0.5 unit/hr.)
    2.) PRIMING: Flush 20 mL of infusion through all IV tubing before infusion begins (to saturate insulin binding
    sites in tubing.)
    3.) THRESHOLD: IV insulin is indicated in any critically ill patient with persistent BG > 140 mg/dl; consider use
    if BG > 120 mg/dl.
    4.) TARGET BLOOD GLUCOSE (BG) LEVEL: 90-120 mg/dL
    5.) BOLUS & INITIAL INSULIN INFUSION RATE: If initial BG > 150, divide initial BG level ( mg/dL) by 70, then
    round to nearest 0.5 unit for bolus AND initial infusion rate. If initial BG < 150 mg/dl, divide by 70 for initial
    infusion rate only ( i.e., NO bolus.)
    Examples: 1) Initial BG = 335 mg/dL: 335 70 = 4.78, rounded up to 5: Give 5 units IV bolus + start infusion @ 5 units/hr.
    2) Initial BG = 148 mg/dL: 148 70 = 2.11, rounded down to 2: Start infusion @ 2 units/hr ( NO bolus.)
    Blood Glucose (BG) Monitoring
    1.) Check BG hourly until stable (dened as 3 consecutive values in target range.) In hypotensive patients, capillary
    blood glucose ( i.e., ngersticks) may be inaccurate and obtaining a blood sample from an indwelling vascular
    catheter is preferable.
    2.) Then check BG Q 2 hours; once stable x 12-24 hours, BG checks can be spaced to Q 3-4 hours IF:
    a) no signicant change in clinical condition AND b) no signicant change in nutritional intake.
    3.) If any of the following occur, consider the temporary resumption of hourly BG monitoring, until BG is again stable:
    a) any change in insulin infusion rate (i.e. BG out of range)
    b) signicant changes in clinical condition
    c) initiation or cessation of steroid or pressor therapy d) initiation or cessation of dialysis or CVVH
    e) initiation, cessation, or rate change of nutritional support (TPN, PPN, tube feedings, etc.)
    Changing the Insulin Infusion Rate
    If BG < 50 mg/dL:
    HOLD INSULIN INFUSION. Give 1 Amp (25 g) D50 IV; recheck BG Q 10-15 minutes
    When BG > 90 mg/dL, wait 1 hour, recheck BG. If still > 90 mg/dL, restart infusion
    at 50% of most recent rate.
    If BG 50-69 mg/dL:
    HOLD INSULIN INFUSION. If symptomatic (or unable to assess), give 1 amp (25 g) D50 IV;
    If asymptomatic, consider 1/2 Amp (12.5 g) D50 IV or 8 ounces juice PO; recheck
    BG Q 15-30 minutes.
    When BG > 90 mg/dL, wait 1 hour, recheck BG. If still > 90 mg/dL, restart infusion
    at 75% of most recent rate.
    1
    recheck BG Q 15 minutes.
    e t a R n o i s u f n I n i l u s n I e h t g n i g n a h C ) . d t n o c (
    G B f I / g m 0 7 : L d
    : 1 P E T S L E V E L G B T N E R R U C e h t e n i m r e t e D N M U L O C a s e i f i t n e d i - : e l b a t e h t n i
    L d / g m 9 8 - 0 7 G B L d / g m 9 1 1 - 0 9 G B L d / g m 9 7 1 - 0 2 1 G B G B L d / g m 0 8 1
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    S N O I T C U R T S N I *
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    D E G N A H C N U G B
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    G B r h / L d / g m 0 2 > y b
    w o l e b e e s

    G B r h / L d / g m 0 4 > y b G B r h / L d / g m 0 8 > y b G B r h / L d / g m 0 2 1 > y b n i m 0 3 X N O I S U F N I D L O H


    n e h t 2 y b E S A E R C E D

    ; N O I S U F N I N I L U S N I D L O H
    n e h w ; n i m 0 3 - 5 1 Q G B k c e h c
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    N e t o r o f s e u l a v t r e v n o c o T :
    o t L d / g m m o r f e s o c u l g
    . 1 5 5 5 0 . 0 y b y l p i t l u m , L / l o m m
    * D n e p e i d t n o g n h c e i l ni a c l ci , s e c n a t s m u c r inf s u i p y t s e t a r n o i a c l l e g n a r y b n e e w t e 2- 0 1 n u i s t h / . r D s e s o
    e r o l p x e o t d e i f i t o n e b d l u o h s D M e l b i s n o p s e r e h t , d e r i u q e r f i , d n a , l a u s u n u e r a r h / s t i n u 0 2 f o s s e c x e n i
    ) . c t e , s r o r r e n o i t u l i d s a h c u s , s m e l b o r p l a c i n h c e t g n i d u l c n i ( s r o t c a f g n i t u b i r t n o c l a i t n e t o p r e h t o
    *
    E T A R N O I S U F N I N I S E G N A H C r o a t l e d ( : e t a r n o i s u f n i t n e r r u c y b d e n i m r e t e d e r a )
    e t a R n o i s u f n I t n e r r u C
    ) r h / s t i n u (
    e g n a h C e t a R =
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    1 5 . 0 3 <
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    STEP 2: Determine the RATE OF CHANGE from the prior BG level - identifies a CELL in the table - Then move right
    for INSTRUCTIONS:
    [Note: If the last BG was measured 2-4 hrs before the current BG, calculate the hourly rate of change. Example: If the BG at 2PM was
    150 mg/dL and the BG at 4 PM is now 120 mg/dL, the total change over 2 hours is -30 mg/dL; however, the hourly change is
    -30 mg/dL 2 hours = -15 mg/dL/hr.]
    2

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