Insulin Dosage Chart (Page 2 of 3) in pdf

Page 2 of 3

Portland Continuous Intravenous Insulin Protocol ICU TARGET BLOOD GLUCOSE 100 to 150mg/dl

Version 2008.1: ICU PHASE 2

ICU: May titrate Insulin Infusion between 0-30 units /hour using the following as GUIDELINES to rapidly (within 3 hrs) achieve and maintain BG in target

range (100-150). Round insulin Infusion to the nearest tenth of a unit (0.1) when necessary.

Blood

Note: If ANY BG is less than 40mg/dl or greater than 450mg/dl, obtain confirmatory laboratory BG

Glucose (BG)

Action:

Less Than 60

Stop Insulin:

•

If not alert or if NPO: give 15 ml of D50W IV; If < 40 give 25 ml of D50W IV

If alert and taking PO give 8 ounces of juice PO OR 6 glucose tablets PO

•

Recheck BG every 30 minutes until greater than 90mg/dl

•

If next BG is < 50mg/dl: Double amount of previous treatment; If next BG is 50 – 65 mg/dl repeat treatment

& recheck BG in 30 minutes

When BG greater than 100mg/dl: Restart Insulin rate at 50% of previous rate

•

60 to 79

Stop Insulin:

If Previous BG greater than 110mg/dl OR if symptomatic from hypoglycemia:

•

If NPO: give 15 ml of D50W IV; <OR> IF taking PO: give 4-6 ounces of juice OR 3 glucose tablets PO.

Recheck BG every 30 minutes until greater than 90mg/dl

•

If next BG remains 60 - 79 mg/dl : Repeat previous treatment

•

When BG greater than 90mg/dl: Restart Insulin rate at 50% of previous rate

& recheck BG in 30 minutes

•

80 to 99

If greater than last test: Decrease rate by 0.3 units / Hour

•

If lower than last BG by more than 30 mg/dl: Stop drip & recheck BG in 30 minutes (see bold * order)

& recheck BG in 30 minutes

If lower than last BG by 15 – 30 mg/dl: Decrease rate by HALF (50%)

•

If lower than last BG by 7 – 14 mg/dl: Decrease rate by 0.5 Units / Hour

If equal to last BG or lower than last BG by less than 7 mg/dl: Decrease rate by 0.3 Units / Hour

•

*If infusion turned off, recheck BG in 30 min, when BG greater than 100mg/dl restart at 50% of previous rate

recheck BG in 30 minutes

Recheck BG every 30 minutes until greater than 90mg/dl

•

100 to 150

•

If higher than last BG by more than 10mg/dl: Increase rate by 0.5 Units / Hour

Target Range

If lower than last BG by more than 40 mg/dl: Stop drip & recheck BG in 30 minutes (see bold ** order)

•

EXCELLENT!

& recheck BG in 30 minutes

•

If lower than last BG by 21–40 mg/dl: Decrease rate by HALF (50%)

May titrate

If lower than last BG by 10-20mg/dl: Decrease rate by 0.5 Units / Hour

•

drip in ICU to

** If infusion turned off, recheck BG 30 min, if /when BG greater than 130 mg/dl restart at 50% of previous rate

maintain this

•

If within 10mg/dl of last BG same rate… unless the following applies:

range. See

FOR ANY BG in this range (even if within 10 mg/dl of last test) the following ALWAYS applies:

•

Suggestions:

º BG has consistently decreased each of last 4 measurements: Decrease rate by an additional 0.3 Units / Hour

º BG has consistently increased each of last 4 measurements: Increase rate by an additional 0.2 Units / Hour

151 to 175

•

If higher than last BG by more than 50mg/dl: Increase rate by 2 Units/Hour

If higher than last BG by 20 - 50mg/dl: Increase rate by 1 Unit / Hour

•

If higher than last BG by 0 - 20mg/dl: Increase rate by 0.5 Units / Hour

•

If lower than last BG by 1 - 20 mg/dl: Same rate

If lower than last BG by 21 - 40mg/dl: Decrease rate by 1 Unit / Hour

•

If lower than last BG by 41 – 60 mg/dl: Decrease rate by HALF (50%) and recheck BG in 30 minutes

•

If lower than last BG by more than 60 mg/dl: Stop drip & recheck BG in 30 minutes (see bold ** order below)

**If infusion turned off, recheck BG 30 min, if / when BG greater than 150mg/dl restart at 50% of previous rate

176 to 200

•

If higher than last BG by more than 30mg/dl: Increase rate by 2 Units/Hour & bolus with 3 units IV

If higher than last BG by 0 - 30mg/dl: Increase rate by 1 Unit / Hour & bolus with 2 units IV

•

If lower than last BG by 1 – 20: Increase rate by 1 Unit / Hour & bolus with 2 units IV

•

If lower than last BG by 21 to 50mg/dl: Same rate

If lower than last BG by 51 – 80mg/dl: Decrease rate by HALF (50%) and recheck BG in 30 minutes

•

If lower than last BG by more than 80mg/dl: Stop drip & recheck BG in 30 minutes (see bold ** order below)

•

Recheck BG in 30 minutes. Repeat BG every 30 minutes until less than 175mg/dl

**If infusion turned off, recheck BG 30 min, if / when BG greater than 150mg/dl restart at 50% of previous rate

201 to 225

•

If lower than last BG by more than 80mg/dl: Decrease rate by HALF (50%)

If lower than last BG by 30 –80mg/dl: Continue same rate

•

If lower than last BG by 0 – 30: Increase Insulin rate by 1 Unit / Hour & bolus with 2 units IV

•

If higher than last BG by 1- 20mg/dl: Increase Insulin rate by 2 Units / Hour & bolus with 4 units IV

If higher than last BG by more than 20mg/dl: Increase Insulin rate by 3 Units/Hour & bolus 6 units IV

•

Recheck BG in 30 minutes. Repeat BG every 30 minutes until less than 175mg/dl

226 to 275

If lower than last BG by more than 100 mg/dl: Decrease rate by HALF (50%)

•

If lower than last BG by 50 – 100 mg/dl: Continue same rate

If lower than last BG by less than 50mg/dl OR higher than last BG:

•

º BOLUS with 6 units Regular Insulin IV AND Increase Insulin rate by 2 Units / Hour

•

If BG remains 226 - 275 mg/dl and has not decreased after 3 consecutive increases in Insulin:

Give DOUBLE previous IV BOLUS dose up to a maximum of 24 units AND

DOUBLE Insulin drip rate -- up to a maximum of 20 units / hour

If on 20 units/hour and no response after 4 maximum boluses – CALL MD for further orders

Recheck BG in 30 minutes. Repeat BG every 30 minutes until less than 175mg/dl

•

Greater than

•

If lower than last BG by more than 150 mg/dl: Decrease rate by HALF (50%)

275

If lower than last BG by 101-150mg/dl : Same rate

•

If lower than last BG by 0- 100mg/dl OR if higher than last BG:

•

º BOLUS with 10 Units Regular Insulin IV AND DOUBLE Insulin rate up to a maximum of 30 units / hour

If BG remains greater than 275 mg/dl and has not decreased after 3 consecutive increases in Insulin:

•

Give DOUBLE previous IV BOLUS dose up to a maximum of 40 units AND

DOUBLE Insulin drip rate -- up to a maximum of 30 units / hour

If on 30 units/hour and no response after 4 maximum boluses – CALL MD for further orders

•

Recheck BG in 30 minutes. Repeat BG every 30 minutes until less than 175mg/dl

IF BG GREATER THAN 300 for 4 CONSECUTIVE READINGS: CALL MD FOR ADDITIONAL IV BOLUS ORDERS

Physician Signature___________________________________Date:__________Time:_________

Insulin Dosage Chart Page 2

Related Articles

Related forms

Related Categories