What Insulin Protocols Do You Use?

[Cheers_G, BSN, RN]

Hi everyone!

We are doing research on insulin protocols, so I was wondering what insulin protocols your hospitals use. You can keep the hospital private if you'd like but plz just maybe mention state/city?

Thank you!!!

[MaxAttack, BSN, RN]

One hospital used a mild, moderate, and severe sliding scales while another used a multiplier. I found a better degree of control with the multiplier. Both targeted glucose levels in the 140-160's if I remember right. I wish I had copies of the actual protocols but if you have any specific questions I can probably remember some detail. Ft Lauderdale, FL

[CCU BSN RN]

We have a few separate insulin drip protocols for ICU, both of which I kind of hate.

Cardiac surgery protocol with target glucose 110-160, basically has you start for glucose over 150, and go up or down by 1 unit if outside range, but involves giving boluses which is a pain and IMO subject to more room for error, especially since we can't bolus from the pump and there is no great way to docent the boluses in our eMAR.

Medical protocol with target glucose 120-180, involves starting in a certain column based on someone's glucose and then moving to a new column if sugar is too high/too low. There aren't boluses but again, there's no great way to chart which column you're in, and if you forget or aren't told in report it's a pain. Also it has doses down to .1, and being on 4.7 units or 8.3, with a dosage that changes every hour...it seems there's a lot of room for error when you need to remember a new glucose levels, column, and obscure dose every hour.

Both allow us to start monitoring q2h once glucose stabilizes, neither involve standard frequent lab orders or IVF because we're not specifically treating DKA.

[MountaineerFan57, BSN]

Cardiac surgery patients use the Portland Protocol (link below.)

http://www.sarasotaanesthesia.com/documents/portlandinsulinprotocol.pdf

our MICU uses a formula that I unfortunately can’t remember right now.

[MunoRN, RN]

35 minutes ago, MountaineerFan57 said:

Cardiac surgery patients use the Portland Protocol (link below.)

http://www.sarasotaanesthesia.com/documents/portlandinsulinprotocol.pdf

our MICU uses a formula that I unfortunately can’t remember right now.

Are your cardiac surgeons still using the Portland Protocol, or do you mean they used to?

[MountaineerFan57, BSN]

13 hours ago, MunoRN said:

Are your cardiac surgeons still using the Portland Protocol, or do you mean they used to?

Sorry for the confusion, Cardiac surgery currently uses it. However, I prefer the MICU formula we use over the Portland.