Step-Down Insulin Infusion Orders Page 2
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2Step-Down Insulin Infusion Orders
page 2 of 2
Changing the Insulin Infusion Rate
4.
The Change in Infusion Rate depends on 1) the Current rate; 2) Last Measurement; and 3) Rate of Change
Glucose less than 50 mg/dL: Stop Insulin Infusion. Give 25 grams (1 amp) of D50 IV. Recheck glucose every 15
* Orders incomplete unless Page 2 of 2 completed and signed
minutes. When Glucose greater than 100 mg/dL, wait one hour, restart insulin infusion at Last Rate x 0.5.
a. Glucose = 50 to 74 mg/dL: Stop Insulin Infusion.
i. If symptomatic or unable to assess, then give 25 grams (1 amp) of D50 IV. Recheck glucose every 15
minutes. When Glucose greater than 100 mg / dL restart Insulin infusion at Last Rate x 0.6.
ii. If asymptomatic, give 12.5 grams (1/2 amp) of D50 IV or 8 ounces of orange juice. Recheck Glucose
every 15 minutes. When Glucose greater than 100 mg / dL restart Insulin infusion at Last Rate x 0.6.
b.
Glucose 75 to 499 mg/dL use chart below:
i. (1) Determine the Hourly Rate of Change of glucose levels by taking the current measurement and
subtracting the previous measurement; then divide by the hours between the measurements.
Example Current Glucose = 130, previous Glucose was 200, 2 hours between measurements:
Hourly Rate of Change = 130 – 200 = (- 70); (- 70) divided by 2 hours = (- 35). (Negative numbers are in
parenthesis)
ii. (2) Locate correct Current Glucose section, then use Hourly Rate of Change to find adjustment to rate.
Round to nearest 0.5 Units / hour unless rate is less than 1 unit / hour then round to
nearest tenth.
1. Current Glucose is 75 to 99
Hourly Rate of Change in Glucose Level
Insulin RATE
greater than 0
No Change
0 to (- 25)
New Rate = Current Rate x 0.8
A change of (- 26) or more
Hold Infusion until Glucose greater than 100 mg / dL restart Insulin
infusion at Last Rate x 0.6
2.
Current Glucose is 100 to 139
Hourly Rate of Change in Glucose Level
Insulin RATE
greater than 25
New Rate = Current Rate x 1.2
25 to (- 25)
No Change
(- 26) to (- 50)
New Rate = Current Rate x 0.8
Hold Infusion for 30 minutes. New Rate = Current Rate x 0.6
A change of (- 51) or more
3. Current Glucose is 140 to 199
Hourly Rate of Change in Glucose Level
Insulin RATE
greater than 50
New Rate = Current Rate x 1.4
0 to 50
New Rate = Current Rate x 1.2
(- 1) to (- 50)
No Change
(- 51) to (- 75)
New Rate = Current Rate x 0.8
A change of (- 76) or more
Hold Infusion for 30 minutes. New Rate = Current Rate x 0.6
4.
Current Glucose is 200 to 499
Hourly Rate of Change in Glucose Level
Insulin RATE
greater than 0
New Rate = Current Rate x 1.4
0 to (- 25)
New Rate = Current Rate x 1.2
(- 26) to (- 75)
No Change
(- 76) to (- 100)
New Rate = Current Rate x 0.8
A change of (- 101) or more
Hold Infusion for 30 minutes. New Rate = Current Rate x 0.6
(
) Verbal Order Verification
Prescriber’s Signature: ________________________________________________
Patient Identification
Date/Time: ________________________________________________
CHH-1435 Originated: 10/2007, Revised 6/2008
White: Chart
Yellow: Pharmacy
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