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Insulin is a HIGH-ALERT medication. Always verify calculations with a second clinician. Follow your institution's protocol. Monitor blood glucose hourly initially. Have D50 at bedside.
Calculate IV insulin infusion rates based on blood glucose
Standard: Target 140-180 mg/dL | Aggressive: Tighter control for specific populations
| Blood Glucose (mg/dL) | Insulin Rate (units/hr) | Action |
|---|---|---|
| <70 | 0 | HOLD drip, give D50 25-50 mL IV, recheck in 15 min |
| 70-109 | 0.5 | Continue, recheck in 1 hour |
| 110-139 | 1 | Continue, recheck in 1 hour |
| 140-179 | 1.5 | Target range - continue, check q2h when stable |
| 180-219 | 2 | Increase rate, recheck in 1 hour |
| 220-279 | 3 | Increase rate, recheck in 1 hour |
| 280-349 | 4 | Increase rate, recheck in 1 hour |
| ≥350 | 5 | Consider 10-unit IV bolus, then drip, recheck in 1 hour |
* This is a sample protocol. Always follow your institution's approved protocol.
| Patient Population | Target Range | Rationale |
|---|---|---|
| Most ICU patients | 140-180 mg/dL | Balance efficacy and hypoglycemia risk |
| Cardiac surgery (periop) | 110-140 mg/dL | May reduce surgical site infections |
| Stroke patients | 140-180 mg/dL | Avoid hypoglycemia worsening outcomes |
| Traumatic brain injury | 140-180 mg/dL | Tight control may worsen brain injury |
| DKA/HHS | 200-250 mg/dL initially | Too rapid correction risks cerebral edema |
The standard concentration is 100 units of regular insulin in 100 mL of 0.9% NaCl (1 unit/mL). This makes it easy to match units/hr to mL/hr on the pump. Always use regular insulin (not NPH or long-acting) for IV drips.
Check hourly until glucose is stable within target range for 4 hours, then every 2 hours. Always recheck 1 hour after any rate change. For hypoglycemia, recheck 15 minutes after giving dextrose.
For most patients, start at 0.1 units/kg/hr (e.g., 7 units/hr for a 70 kg patient). For DKA, initial rate is typically 0.1 units/kg/hr after an optional bolus. Adjust based on response.
Some protocols recommend a 10-unit IV bolus for glucose >350 mg/dL before starting the drip. However, many institutions avoid boluses due to hypoglycemia risk. Follow your local protocol.
Immediately HOLD the drip. Give 25-50 mL of D50 IV push (1 amp = 50 mL = 25g dextrose). Recheck glucose in 15 minutes. Once >100 mg/dL, restart drip at 50% of previous rate. Never leave drip running during hypoglycemia.