Icu Insulin Orders
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2D i a b e t e s
t r e a t m e n t
a l g o r i t h m s
ICU Insulin Orders –
Iv Insulin Infusion Protocol
publication # e45-12614
revised 2/21/08
(Not intended for use in patients with type 1 diabetes, DKA or hyperglycemic hyperosmolar states)
1) Start an IV Insulin Flow Sheet and keep record at bedside
2) Start IV:
D5W at 100ml/h
_____
D5W½NS at
ml/h
_____
_______
Other:
_____
_______________________________________________
3) Mix standard insulin drip:
100 units Regular, aspart or glulisine insulin in 100 cc NS (1 unit insulin /cc) (Circle one)
u
4) Give initial insulin bolus:
Bolus units of I.V. insulin = Glucose ÷ 100 (e.g. if glucose = 240 mg/dL, give 2.5 units)
u
5) Start insulin infusion:
Initial infusion rate of insulin units/h = Glucose ÷ 100 ( e.g. if glucose=240, begin 2.5 units/h)
u
6) target range for glucose:
Low Target (circle one)
High Target (circle one)
u
70
100
or
mg/dL
110
120
140
or
mg/dL
________
________
7) Monitor capillary (finger stick) glucose every hour:
Obtain lab glucose if finger stick BG is <40 or >400 mg/dL
u
Change frequency of glucose monitoring to:
u
_______________________________
8) Adjust insulin infusion rate each hour after initial insulin bolus and infusion
Start on Algorithm 1 (No patient begins on Algorithm 3 or 4 without endocrine service authorization)
Start on Algorithm 2 (s/p CABG, transplant, glucocorticoids or >80 units/d insulin outpatient)
Move up or down on the same algorithm each hour if glucose remains outside the target range
u
Advance to the next algorithm (i.e. 1g2 etc.) if outside target range at highest infusion rate
u
Treat for hypoglycemia is glucose <60 mg/dL (see # 9)
u
Decrease 1 algorithm (i.e. 3g2 etc.) if glucose 60-69 mg/dL x 2 or decreases >60 mg/dL in 1 hour
u
Algorithm 1
Algorithm 2
Algorithm 3
Algorithm 4
BG
units/h
BG
units/h
BG
units/h
BG
units/h
<60 = Hypoglycemia (See #9 for treatment)
<70
Off
<70
Off
<70
Off
<70
Off
70–109
0.2
70–109
0.5
70–109
1
70–109
1.5
110–119
0.5
110–119
1
110–119
2
110–119
3
120–149
1
120–149
1.5
120–149
3
120–149
5
150–179
1.5
150–179
2
150–179
4
150–179
7
180–209
2
180–209
3
180–209
5
180–209
9
210–239
2
210–239
4
210–239
6
210–239
12
240–269
3
240–269
5
240–269
8
240–269
16
270–299
3
270–299
6
270–299
10
270–299
20
300–329
4
300–329
7
300–329
12
300–329
24
330–359
4
330–359
8
330–359
14
330–359
28
>360
6
>360
12
>360
16
>360
32
1 of 2– icu insulin orders – iv insulin infusion protocol – revised 2/21/08
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