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PHYSICIAN’S ORDERS: IV Insulin Infusion Protocol

NOTED BY/
ORDERED TIME DATE
GOAL BLOOD GLUCOSE 75 mg/dL – 120 mg/dL AND
DATE TIME SIGNATURE
Initial Order START PROTOCOL
This protocol is NOT for treatment of diabetic ketoacidosis or hyperosmolar coma
Primary IV infusion: D10W at 30 ml/hr UNLESS patient is on Total Parenteral
IV Nutrition (TPN) with Dextrose 10% or greater OR on enteral feedings
(continuous carbohydrate ie tube feedings).
Secondary IV infusion: 100units of regular insulin/100ml NS
The dextrose infusion must be continued for at least 2 hours after insulin is
discontinued. ALL IVPB’S IN NORMAL SALINE IF COMPATIBLE.
Start INITIAL INSULIN INFUSION RATE (100 units Regular Insulin/100 mL 0.9%
Insulin Sodium Chloride):
Blood Glucose (mg/dL) Initial Insulin Infusion Rate
ƒ 75 - 150 = 1 unit IV push then 1 unit per hour
ƒ 151- 250 = 2 units IV push then 2 units per hour
ƒ 251- 350 = 3 units IV push then 3 units per hour
ƒ Above 350 = 4 units IV push then 4 units per hour
ADJUSTING INSULIN INFUSION RATE AFTER INITIAL RATE HAS BEGUN:
ƒ Choose Adjustment Table 1, 2 or 3 based on last insulin infusion rate
before adjustment.
ƒ Determine the last BS result and locate it in the first column.
ƒ Determine the current BS and locate that in the row across the top.
ƒ Determine the rate of change at the intersection of the row and column.
ƒ Minimum infusion rate is 0.5units/hour even if the calculated rate is less.
ƒ If insulin drip is STOPPED for one (1) hour or more, check BS and
restart using Initial Insulin Infusion (as above)
For insulin infusion rates >8 units/h, do not exceed, where indicated, the
(MAXIMUM INFUSION) rates in table 3.
Use Glucometer values only for insulin protocol. (Levels that need lab
confirmation must still be obtained for linearity)
Blood
Glucose Blood glucose should be checked every two (2) hours, except
a. ) Check every one (1) hour if:
ƒ BS is below 120 until 2 Blood Sugars are over 75
ƒ Whenever insulin drip is decreased by 2 units/hour or more ( * in tables)
b.) Check every three (3) hours if 3 consecutive BSs are in the range of 80-120.
For glucose levels less than 75mg/dl:
ƒ Stop IV insulin infusion but continue dextrose infusion
ƒ For Blood Glucose level of 40 to 60 mg/dl; administer 12.5 Gm of Dextrose
50% Water IVP
ƒ For Blood Glucose level of less than 40mg/dl; administer 25 Gm of Dextrose
50% Water IVP
ƒ Repeat BS in 1 hour and follow Initial Infusion Rate as above.
ƒ If the Insulin Infusion is held twice within 12 hours for a BS<75mg/dl, notify
physician.
Call Physician if:
ƒ Blood Glucose level is less than 40mg/dl
ƒ Insulin infusion is greater than12 units/ hour
ƒ Patient needs short-acting insulin at meal time
Physician Signature: Date: Time:
Acknowledgement – protocol based on “Balkin-Huntington Hospital Protocol”
Version 04/19/2007 Scanned to Pharmacy Date: Time:
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ADJUSTMENT TABLE 1: Last Insulin Infusion Rate less than 4.5 UNITS PER HOUR
LAST BS CURRENT BS
LAST BLOOD SUGAR

↓ 75-99 100-120 121-140 141-170 171-200 201-300 Above 300

75-99 -0.2 +0.2 +1 +1.5 +2 +2.5 +3

100-120 -0.5 0 +0.5 +1 +1.5 +2 +2.5
121-140 -1 -0.5 +0.5 +1 +1.5 +2 +2.5
141-170 -1 -1 -0.5 +0.5 +1 +2 +2.5
171-200 -1.5 -1 -0.8 +0 +1 +1.5 +2
201-300 -2* -1.5 -1.5 -0.8 +0 +1 +2
Above 300 -3* -2.5* -2* -1.5 -0.5 +1.0 +2.0

ADJUSTMENT TABLE 2: Last Insulin Infusion Rate 4.5 – 8 UNITS PER HOUR
LAST BS CURRENT BS
LAST BLOOD SUGAR

↓ 75-99 100-120 121-140 141-170 171-200 201-300 Above 300

75-99 -1 +0.5 +1 +1.5 +2 +2.5 +3
100-120 -1 0 +1 +1 +1.5 +2 +2.5
121-140 -1.5 -1 +0.5 +1 +1.5 +2 +2.5
141-170 -2.5* -2* -1 +1 +1.5 +2 +2.5
171-200 -3.5* -3* -1.5* 0 +1 +1.5 +2.0
201-300 -4* -3.5* -2.5* -1.5 0 +1 +2
Above 300 -5* -4* -3.5* -2.5* -1.5* +1.0 +2.0

ADJUSTMENT TABLE 3: Last Insulin Infusion Rate ABOVE 8 UNITS PER HOUR
LAST BS CURRENT BS
LAST BLOOD SUGAR

↓ 75-99 100-120 121-140 141-170 171-200 201-300 Above 300

75-99 -1.5 +0.5 +1 +1.5 +2 +2.5 +3
100-120 -2.0* 0 +1 +1 +1.5 +2.0 +2.5
121-140 -2.5* -1.5 +0.5 +1 +1.5 +2 +2.5
141-170 -3.5* -3* -1.5 +1 +1.5 +2 +2.5
171-200 -4*/M 15 -3.5* -2.5* 0 +1 +1.5 +2.0
201-300 -5*/M 12 -4.5*/M -3.5* -2.5* 0 +1 +2
15
Above 300 -6*/M 10 -5*/M 12 -4* -3.5* -2.5* +1 +2.0
Reference: Experience of a Community Hospital ICU with Intensive Glucose Management, M. Balkin, MD Huntington
Hospital; presented at the American Diabetes Association 65 Scientific Sessions

Acknowledgement – protocol based on “Balkin-Huntington Hospital Protocol”

Version 04/19/2007