Hi all~ I work in ICU and often times am running Regular insulin drips on DKA or post-surgical pt.'s. Our hospital doesnot have an insulin drip protocol, it is up to the ICU nurse's discretion on titrating the dose, which works out fine if the nurse is attentive enough and has enough critical thinking skills, but I have seen pt.'s bottoming out or sugars being all over the place with frequent titrations. Just wondering if there's a good protocol out there that can be used as a "guideline" for insulin drips, or if anyone has any input. At my previous hospital we used to have one that worked pretty well, with 4 different algorhythms and slow titrations, but I don't have a copy. Any examples would be greatly appreciated.
This is from the Yale Diabetes Center Diabetes Facts & Guidelines:
DKA (Adults Only): Day 1 Goals
Stabilize hemodynamics, replete volume, correct acidosis/electrolytes, search for precipitating cause.
Give R insulin 10 units IV bolus, then run insulin drip @ 5 - 10 units per hr. Goal is to decrease glucose by 50 - 75 mg/dl/hr. If BG is decreased by > 100 mg/dl/hr, reduce drip by 25 - 50%. If even greater BG drop occurs, hold drip for 1 hr and restart at 50% of prior rate. Check BG q 1 hr, and adjust drip as needed.
IV NS to replete fluid aggressively. Consider IV NaHCO3 if pH < 6.9 & HCO3 <5. Add K to IV fluids once K < 5.5, pt NOT in renal failure and adequate urine output documented. (FOLLOW SERUM K CLOSELY & REPLETE AGGRESSIVELY).
Once BG < 250 mg/dl, clamp* the glucose at 200 - 250 with 1 - 2 units insulin and 5 - 10 g dextrose per hr. (D5 -D10 @100 cc/hr until anion gap is closed (12 or lower)
Day 2: Leave on insulin drip is still NPO. To switch from IV to sub q insulin, maintain drip 1 - 2 hrs after initial sub q injection. (t1/2 of regular insulin IV is very short, so need to have time for SQ insulin to work.
*With HHS, no need to clamp since no acidosis.Leave on IV insulin until BG <200 and pt ready to eat. Often better to wait to start SQ insulin until next day at breakfast.
I realize this isn't a step by step scale to adjust drip based on BG. I'll get one from work tomorrow. Is there not a good endo to consult at your facility?
Last edit by Myxel67 on Apr 4, '07