Insulin Drip Protocol

Standard Insulin concentration is 1 U regular insulin per 10 ml saline

Tubing should be flushed with 50ml of solution before use for either a 250cc or 500cc bag.

Capillary glucose measured hourly for the first 6-8 hours, then every 2 hrs.

Initial rate: 1 U per hour for patients with NIDDM and men with IDDM, thin women with IDDM may be started at 0.5 U/hr.

Loading dose: if glucose > 200 = 0.075-0.1 U/kg SQ, >300 = 0.1-0.125 U/kg, if DKA give 0.2 U/kg.

DOSING TABLE:

Capillary Glucose	Action
<70	D/C for 30 min, give 15-20 ml of D50, remeasure in 30 min, If greater than 100, then resume drip at 1 U per hour. Continue glucose infusion.
70-120	Decrease rate by 0.3 U/hr.
121-180	No change in rate.
181-240	Increase rate by 0.3 U/hr.
241-300	Increase rate by 0.6 U/hr.
> 300	Increase rate by 1 U/hr

Most adults require minimum of 10 g of glucose/hr and additional KCl. (D10 in 1/2 NS with 20 KCl at 100 cc/hr.)

Reference: Hirsch I, Paauw D, Brunzell J, "Inpatient Management of Adults with Diabetes". Diabetes Care, 1995. 18:6, pp870-877.

MLT