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    Nursing Education Department: Insulin Protocols

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    Sitti Mardiya Sariol
    This document provides protocols for administering insulin to diabetic patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. It outlines protocols for administering insulin to non-critically ill diabetic patients, both with and without nutritional intake. It also details a protocol for continuous intravenous insulin infusion for diabetic and non-diabetic patients with high blood glucose levels. The document provides target blood glucose ranges and guidelines for adjusting insulin rates based on blood glucose monitoring. It notes situations that require physician referral.

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    © All Rights Reserved
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    Nursing Education Department: Insulin Protocols

    Uploaded by

    Sitti Mardiya Sariol
    59 views16 pages
    This document provides protocols for administering insulin to diabetic patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. It outlines protocols for administering insulin to non-critically ill diabetic patients, both with and without nutritional intake. It also details a protocol for continuous intravenous insulin infusion for diabetic and non-diabetic patients with high blood glucose levels. The document provides target blood glucose ranges and guidelines for adjusting insulin rates based on blood glucose monitoring. It notes situations that require physician referral.

    Original Title

    INSULIN INJECTION

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    This document provides protocols for administering insulin to diabetic patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. It outlines protocols for administering insulin to non-critically ill diabetic patients, both with and without nutritional intake. It also details a protocol for continuous intravenous insulin infusion for diabetic and non-diabetic patients with high blood glucose levels. The document provides target blood glucose ranges and guidelines for adjusting insulin rates based on blood glucose monitoring. It notes situations that require physician referral.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    59 views16 pages

    Nursing Education Department: Insulin Protocols

    Uploaded by

    Sitti Mardiya Sariol
    This document provides protocols for administering insulin to diabetic patients at the Prince Faisal bin Khalid Cardiac Center in Abha, Saudi Arabia. It outlines protocols for administering insulin to non-critically ill diabetic patients, both with and without nutritional intake. It also details a protocol for continuous intravenous insulin infusion for diabetic and non-diabetic patients with high blood glucose levels. The document provides target blood glucose ranges and guidelines for adjusting insulin rates based on blood glucose monitoring. It notes situations that require physician referral.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16
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    The key takeaways are that there are different protocols for administering insulin to diabetic patients depending on whether they are critically ill or not. The goal is to maintain blood glucose levels between 140-180 mg/dl.

    The two main types of diabetes are type 1 diabetes where the body does not produce enough insulin and type 2 diabetes where the body does not produce enough insulin or the cells ignore the insulin.

    The three cardinal signs of diabetes are polydipsia (increased thirst), polyuria (increased urination), and polyphagia (increased hunger).

    Prince Faisal bin Khalid Cardiac Center

    Abha, Saudi Arabia

    Nursing Education
    Department

    INSULIN
    PROTOCOLS

    DISCLAIMER: PROTOCOL are minimum standards but are not


    DEFINITE. The treatment regimen will be dictated by the patient’s
    clinical responses to INSULIN.
    Objective

     At the end of the presentation, RNs will be


    able to:
    1. Determine the indications for initiating a
    specified Insulin protocol.
    2. Be familiar with the procedure of titrating IV
    insulin infusion.
    OVERVIEW OF Diabetes Mellitus
     TWO TYPES:

    1. Insulin Dependent

    2. Non-insulin Dependent
    3. Gestational

     Cardinal Signs:

    1. Polydipsia

    2. Polyuria
    3. Polyphagia

     Diagnostic Test

    HbA1C (>6%)
    WHY DO WE NEED INSULIN?

     Glucose Control
     Fat storage
    What Causes HYPERGLYCEMIA?
     Body not producing enough INSULIN
     Intake of carbohydrates is not balanced with the amount of
    insulin in the body
     Inactivity (e.g. sedentary lifestyle)
     Stress (physical, emotional)
     Steroid drugs
    PFKCC PROTOCOL ON INSULIN
    ADMINISTRATION
    INSULIN PROTOCOL FOR NON-
    CRITICALLY ILL DIABETIC PATIENT
     Measure HBA1c (>6%)
     Target Blood Glucose is 140-180 mg/dl

    • Not taking any OHA: Start HOME DOSE or 0.2-0.3 units/kg/day. For consistently
    ADD CORRECTION (following SLIDING SCALE) SC Insulin if BG is uncontrolled
    >151 mg/dl FOLLOWING Q6 SLIDING SCALE.
    • Taking OHA: Stop OHA, start CORRECTION SC Insulin (following BG:
    TOTALLY NO SLIDING SCALE) if BG is >151 mg/dl FOLLOWING Q6 SLIDING
    NUTRITIONAL SCALE. • Adjust basal
    INTAKE insulin 10-
    20% every
    1-2 days.
    • Adjust
    correction
    • If BG is controlled: Continue HOME DOSE. by 1-2 units
    • If BG is poorly controlled: start 0.2-0.3 units/kg/day INSULIN SC, every 1-2
    Add INTERMEDIATE acting NPH q12 OR LONG ACTING glargine days.
    q24. If BG is still uncontrolled, add CORRECTION DOSES

    EATING (following SLIDING SCALE Q6) 1-4units/50 mg increments.


    INSULIN PROTOCOL FOR NON-CRITICALLY
    ILL DIABETIC PATIENT
    CORRECTION DOSES

    All Type 1 DM should be on basal insulin.


    All OHA should be discontinued preop and pre-contrast.
    INSULIN PROTOCOL FOR NON-CRITICALLY
    ILL DIABETIC PATIENT
     Indication for REFERRAL to a physician:
    1. Uncontrolled Hyperglycemia
    2. Type 1 DM
    3. Hypoglycemia with RBS <70 mg/dl or with symptoms
    4. Suspicion of DKA:
     RBS >250 MG/DL
     Ph >7.3
     HCO3 > 18
     Ketonuria
     Abdominal pain
     vomiting
    CONTINUOUS IV INSULIN INFUSION
    PROTOCOL
     Applicable to all diabetic patient in need of an IV insulin
    infusion.
     Applicable to patients w/o history of DM but BG is ≥180
    mg/dl.
     Monitor BG hourly.
     Target BG is 140-180 mg/dl.
     Insulin should only be diluted with NSS (0.9% NaCl IV fluid) in
    a 1:1 concentration.
     Intraoperative NON-DIABETIC: Start when BG is consistently
    >180mg/dl.
     Intraoperative DIABETIC: Start at the beginning of the
    procedure to maintain BG at 140-180 mg/dl.
    Continuous IV Insulin Infusion Protocol
    PRACTICE TEST
    1. The patient is on continuous IV Insulin Infusion. In the last
    hour, BG was 250 mg/dl. Current check shows a blood glucose
    of 240 mg/dl. If the current infusion rate was 4 unit/hour, what
    will the RN do?
    A. Keep the same rate
    B. Decrease the rate by 2 units/hour
    C. Increase the rate by 2 units/hour

    2. After one hour, the BG further decrease to 225 mg/dl. How


    will the RN set the infusion rate?
    A. Set at 6 units/ hour
    B. Set at 8 units/hour
    C. Do not change the infusion rate
    PRACTICE TEST
    3. In the next hour of checking BG, the finding was 130 mg/dl.
    What is the next nursing action?
    A. Decrease the rate by half of the previous rate
    B. Do not change the rate
    C. Hold the infusion

    2. The following hour, the BG again spike up to 182 mg/dl.


    What will the nurse do?
    A. Resume Insulin infusion at 4 units/ hour.
    B. Keep the infusion on hold.
    C. Resume infusion at 0.5 units/ hour
    References
    1. https://www.diabetes.co.uk/body/insulin.html
    Questions and Suggestions
    will be reviewed by the
    NURSE EDUCATION TEAM
    through your participation in our
    SURVEY MONKEY Feedback Questionnaire.
    Link will be sent through your Whatsapp.
    Jazakallahu Khair!!!

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