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A. INTRAVENOUS INSULIN INFUSION THERAPY
 INDICATIONS AND METHODS:
 Thresholds for Initiation of Intravenous Insulin Infusion Therapy*
 Situation                               Glucose threshold (mg/dL)
 Perioperative care                         >140
 Surgical ICU care                          >110-140
 Nonsurgical illness                        >140-180‡
 Pregnancy                                  >100

 *ICU = intensive-care unit; IV = intravenous.
 ‡The patient who will start IV insulin infusion therapy because of failure of subcutaneous
 management might have a higher threshold for initiation of the infusion than the patient who
 requires IV insulin infusion because of medical conditions, such as myocardial infarction or
 type 1 diabetes with “nothing by mouth” status.


 Suggested Glucose Target Ranges for Intravenous Insulin Infusion Therapy*
 Patient population                                                   Glucose (mg/dL)
 Critically ill surgical patients                                         80-110
 Other surgical and nonsurgical patients                                  90-140
 Women during labor and delivery                                          70-100

 *The American Diabetes Association clinical practice recommendations propose a target
 range during initial treatment of 150 to 200 mg/dL for patients with diabetic ketoacidosis and
 250 to 300 mg/dL for patients with the hyperosmolar hyperglycemic syndrome to minimize
 the risk of cerebral edema, but there are no data to support this recommendation

 Suggested formula for Intravenous Insulin Infusion Therapy*
 Insulin (units per hour) = multiplier X (BG - 60)
 With use of this algorithm manually, the initial multiplier is set at 0.02, and a BG value is
 determined every hour in conjunction with calculation of the units of IV insulin therapy per
 hour. The multiplier is adjusted every hour by 0.01 to obtain the target BG level—if the result
 is less than the target, decrease by 0.01; if within target range, no change is needed; if more
 than the target and the BG level has not decreased by 25%, increase by 0.01. The BG is
 always determined hourly until stable results are achieved; then it is measured every 2 hours.

 Correction of Hypoglycemia
 A policy for correction of hypoglycemia should be the standard of care at all hospitals. The
 preferred treatment of hypoglycemia is IV administration of dextrose when IV access is
 available. The amount of glucose to give is dependent on the BG level at that time and the
 patient’s weight. In a normal-weight patient, 25 g of glucose will raise the BG level by
 approximately 125 mg/dL. The following formula can be used for correction of hypoglycemia:

 (100 - current BG) × 0.4 = amount (mL) of 50% dextrose IV

 Reference
 ENDOCRINE PRACTICE Vol 10 (Suppl 2) March/April 2004 71
 From Atlanta Diabetes Associates and Piedmont Hospital, Atlanta,Georgia.
 Presented at the American College of Endocrinology Inpatient Diabetes and Metabolic Control Conference, Washington, DC, December 14
 and 15,2003.




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Iv insulin infusion therapy

  • 1. A. INTRAVENOUS INSULIN INFUSION THERAPY INDICATIONS AND METHODS: Thresholds for Initiation of Intravenous Insulin Infusion Therapy* Situation Glucose threshold (mg/dL) Perioperative care >140 Surgical ICU care >110-140 Nonsurgical illness >140-180‡ Pregnancy >100 *ICU = intensive-care unit; IV = intravenous. ‡The patient who will start IV insulin infusion therapy because of failure of subcutaneous management might have a higher threshold for initiation of the infusion than the patient who requires IV insulin infusion because of medical conditions, such as myocardial infarction or type 1 diabetes with “nothing by mouth” status. Suggested Glucose Target Ranges for Intravenous Insulin Infusion Therapy* Patient population Glucose (mg/dL) Critically ill surgical patients 80-110 Other surgical and nonsurgical patients 90-140 Women during labor and delivery 70-100 *The American Diabetes Association clinical practice recommendations propose a target range during initial treatment of 150 to 200 mg/dL for patients with diabetic ketoacidosis and 250 to 300 mg/dL for patients with the hyperosmolar hyperglycemic syndrome to minimize the risk of cerebral edema, but there are no data to support this recommendation Suggested formula for Intravenous Insulin Infusion Therapy* Insulin (units per hour) = multiplier X (BG - 60) With use of this algorithm manually, the initial multiplier is set at 0.02, and a BG value is determined every hour in conjunction with calculation of the units of IV insulin therapy per hour. The multiplier is adjusted every hour by 0.01 to obtain the target BG level—if the result is less than the target, decrease by 0.01; if within target range, no change is needed; if more than the target and the BG level has not decreased by 25%, increase by 0.01. The BG is always determined hourly until stable results are achieved; then it is measured every 2 hours. Correction of Hypoglycemia A policy for correction of hypoglycemia should be the standard of care at all hospitals. The preferred treatment of hypoglycemia is IV administration of dextrose when IV access is available. The amount of glucose to give is dependent on the BG level at that time and the patient’s weight. In a normal-weight patient, 25 g of glucose will raise the BG level by approximately 125 mg/dL. The following formula can be used for correction of hypoglycemia: (100 - current BG) × 0.4 = amount (mL) of 50% dextrose IV Reference ENDOCRINE PRACTICE Vol 10 (Suppl 2) March/April 2004 71 From Atlanta Diabetes Associates and Piedmont Hospital, Atlanta,Georgia. Presented at the American College of Endocrinology Inpatient Diabetes and Metabolic Control Conference, Washington, DC, December 14 and 15,2003. 1 of 1Page