- Discussion:
- indicated for resistant
hyperglycemia or
DKA;
- patients treated with the insulin drip typically need 0.3 to 0.4
of insulin per gram of glucose per hour;
- hence, D5W at 100 ml/hr (5 gm/hr) requires 1.5 to 2.0 U/hour of insulin;
- Method of Delivery:
- note that Regular Insulin can bind to the plastic IV tubing;
- 30-50 ml of the infusion solution should be run thru IV tubing & discarded, before the IV tubing
is attached to patient;
- albumin may be added to bind insulin and decrease binding of insulin to solution containers;
- Precautions:
- is possibility of cerebral edema if B.G. is lower from acutely high levels to normal in 2 to 4 hours;
- attempt instead to lower blood glucose at or above 250 for several hours before lowering it to normal,
as this will help to avoid cerebral edema;
- General insulin drip:
- 10 units of regular insulin in 1 liter of D5W at 100 to 200 cc/hr;
- will get good results w/ 1 unit Insulin/hr IV or 100 cc/hr;
Blood Glucose
Rate
"A" Insulin
"B" Insulin
(mg/dl)
(ml/hr)
(U/hr)
(U/hr)
0 -
50
5
0.25
0.50
5 - 100
10
0.50
1.00
100 - 150
15
0.75
1.50
150 - 200
20
1.00
2.00
200 - 250
25
1.25
2.50
250 - 300
30
1.50
3.00
300 - 350
35
1.75
3.50
350 - 400
40
2.00
4.00
> 400
50
3.00
6.00
Alternative method:
- start IV infusion of 5% destrose in water at the rate of 50 ml/hr until patient is taking solid food;
- piggy back to dextrose infusion an infusion of regular insulin using IVAC;
- preparation of the insulin solution: 50 units in 250 ml of 0.9% NS;
- flush 60 ml of infusion mixture thru system and discard before attaching
- set infusion rate: Insulin (units/hr) = (plasma glucose mg/dl)/ 100 (divide by 150 if pt is thin or is not on
Steroids)
- regular insulin 25 units in 250 ml of NS (1 unit/10 ml)
- flush 50 ml thru line before connecting to patient;
- piggyback insulin line to the perioperative maintenance fluid line;
- fluids should contain D5W (100 ml/hr)
