Insulin drip?

  1. Took report on a very very sick pt last night.

    Bg upon arrival was 1300. pt was unresponsive, kussmaul breathing, fever, ketones in urine. Maintaining sat's on 4lt of 0's via n/c. Tachy at about 112-130.

    Nurse giving report had the pt on an insulin gtt at 8u per hour. She had not repeated a finger stick bg in 3 hours. When I did a finger stick the bg came up as 146...Lab repeated and it came back as 555.

    What is your policy on insulin drips and bg checks? If you don't have a policy what is your practice?
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  2. 12 Comments

  3. by   Larry77
    With an insulin drip we usually check BG every 30 minutes unless they are symptomatic then possibly even more often than that.

    I would not have run an insulin drip for 3 hrs without rechecking a BG...yikers.
  4. by   NeuroICURN
    Well...our facility uses different drip constants for insulin gtts. Our insulin drips are mixed as a 1unit/1ml.

    So, the constants are usually anywhere from 0.02 to 0.08. The rate of the insulin gtt is determined by the most recent BGM....and the gtt rate (units/hr) changes with each BGM.

    The way our protocol works is that the goal BGM is 100-150. When the insulin gtt is started, the BGM is checked hourly x3. Then it is continued to be checked hourly until you get three consecutive BGMs that is 100-150, then it can be checked every 2 hours, until it's out of that range again, at which time it goes back to hourly checks.

    Now, if the BGM is below 100, the gtt is stopped for one hour and rechecked again after that hour is up....if it's above 100, then the gtt restarts with the hourly checks x3.

    However, if a constant of 0.04 or higher is being used and the BGM is below 130, then we consider using a lower constant.

    If the pt continues to have high BGMs, then we consider using a higher constant.

    If the insulin gtt has to be stopped more than 2x in the last 24 hours, then we consider stopping the gtt and going back to a Q6h or ACHS schedule with sliding scale coverage.

    It sounds more complicated when it's typed out than what it actually is. Hope this helps.
    Last edit by NeuroICURN on Dec 11, '06
  5. by   RazorbackRN
    Quote from scrmblr
    Took report on a very very sick pt last night.

    Bg upon arrival was 1300. pt was unresponsive, kussmaul breathing, fever, ketones in urine. Maintaining sat's on 4lt of 0's via n/c. Tachy at about 112-130.

    Nurse giving report had the pt on an insulin gtt at 8u per hour. She had not repeated a finger stick bg in 3 hours. When I did a finger stick the bg came up as 146...Lab repeated and it came back as 555.

    What is your policy on insulin drips and bg checks? If you don't have a policy what is your practice?

    BS 110-150 q2. No change in rate.
    BS < 110, Insulin off and recheck hourly. Insulin back on at 1/2 of previous rate when BS >120. Recheck Q2.
    BS > 150 Q1. Increasing by 1 unit hourly until < 150.
  6. by   Larry77
    Yes...good answers from the past two posts. In my case we are usually just using the drip short-term to get a very high BG down and when their sugar is WNL we d/c the drip, But if the patient is headed to the ICU we use a protocol similar to the ones mentioned above.
  7. by   augigi
    What is your hospital's policy, OP?

    In my ICU, we had a strict IV insulin algorithm to keep BSL 5 - 8 mmol/L. Much evidence in the literature that post-cardiac surgery the patients get better outcomes and less infections with very tightly controlled lower BSLs. Depending on the blood sugar, we rechecked in an hour and adjusted infusion if required.
  8. by   Knoodsen
    In my experience, the norm seems to be FSBS q1h when the patient is on an insulin drip. Of course, in the ED, this gets done when and if the nurse has time (we get kinda busy from time to time, you know).
  9. by   BrnEyedGirl
    At our hospital all insulin drips are on a computer program (glucomander),..a small lap top,.enter the glucose level,.it tells you what rate to set the drip and when to do the next accu check,..it beeps when the next accu check is due,...glucomander is somewhat of a "dirty word" on our unit as it is soooo time consuming,...often accu checks every 15-30 minutes,..but after reading these posts I can see how I wouldn't want to have an insulin drip w/out it!
  10. by   augigi
    Sounds excellent - never heard of that, will have to look it up.
  11. by   Christie RN2006
    I had to start an insulin drip on my patient today... my hospital is now using algorithms for patients on insulin drips. You have to do blood sugars every hour until the patient is WNL for at least 4 hours. If their blood sugar doesn't drop by so many points, you have to move to the next algorithm and recheck it in an hour. They also have to get their electrolytes checked 4 hours after starting the drip. Luckily they have the all the orders for it on a printed sheet, so it is pretty simple to follow.
  12. by   CritterLover
    Quote from scrmblr
    took report on a very very sick pt last night.

    bg upon arrival was 1300. pt was unresponsive, kussmaul breathing, fever, ketones in urine. maintaining sat's on 4lt of 0's via n/c. tachy at about 112-130.

    nurse giving report had the pt on an insulin gtt at 8u per hour. she had not repeated a finger stick bg in 3 hours. when i did a finger stick the bg came up as 146...lab repeated and it came back as 555.

    what is your policy on insulin drips and bg checks? if you don't have a policy what is your practice?
    hourly (at least) while on a drip.

    i think our icus have a protocol similar to those described above, but we don't use it in er.

    how we run our drip depends on what doc is ordering it -- sometimes a set rate, sometimes a ss, but always at least hourly glucose checks!
  13. by   lozza81
    if we have an insulin infusion going for our DKA patients, then they are always checked hourly and the infusion is titrated to whatever the sugar level is, we aim to drop the level 3 -4 mmol per hour, and we always recheck electrolytes 4hrly once on infusion.

    Our infusions are also set up as 1 unit equals 1 ml, so,
    If BSL is >20mmol than infusion is set at 8units/hr
    BSL 15 - 19.9 mmol than infusion is set at 4units/hr
    BSL 10 - 14.9 mmol than infusion is set at 2units/hr
    BSL 8 - 9.9 mmol than inusion is set at 1unit/hr
    BSL 6 - 7.9 mmol than infusion is set at 0.5units/ hr
    BSL <6 mmol than infusion is turned off
    Last edit by lozza81 on Dec 13, '06
  14. by   craigrn4er
    If on insulin gtt we check FSBS every 1 hour

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