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Guide-lines for Intravenous Insulin therapy (IVIT)


Indications
1. Hyperglycaemia i.e. caused or exacerbated by high-dose corticosteroid therapy
2. Type 1 diabetes patients who are Nil Per Mouth (NPO)
3. Certain Patients who have had Stroke
4. Certain patients who have had Myocardial Infarction (Heart Attack)
5. Patients in the Peri-operative period who have poor glycaemic control on the Glucose Insulin Potassium (GIK)
regimen or patients who are expecting to fast for more than 24 hours
6. Dose Finding Strategy prior to conversion to subcutaneous insulin therapy
Principles
(a) Never stop Intravenous (IV) in Type 1 diabetes unless absolutely necessary as diabetic ketoacidosis
(DKA) can develop quickly
-Intravenous insulin is rapidly metabolised (its effects last less than 30 minutes after being stopped)

Intravenous Insulin therapy Regimen Initiation


1. Start Intravenous Insulin as follows:
(a) For Glucose levels < 13 mmol/l
1 litre Glucose 5% containing 20 mmol potassium at 125ml/hr
(b) For Glucose levels > 13 mmol/l
1 litre sodium chloride 0.9% containing 20 mmol potassium at 125ml/hr
Switch to Glucose 5% when blood glucose is less than 13 mmol/l.Do not switch back to sodium chloride even if
blood glucose go above 13 mmol/l.
2. Mix 50 units of soluble insulin (Acrapid) with sodium chloride 0.9% made up to 50ml (1 unit/ml)
3. Start the insulin infusion at the rate corresponding to the blood glucose as outlined in the table below and adjust
as necessary
-A fresh insulin infusion should be prepared every 12 hours for immediate use.
Blood Glucose (mmol/l)
>22(If blood glucose is repeatedly
above 22-Call Dr.)
19.1-22.0
16.1-19.0
13.1-16.0
10.1 13.0
7.1 10.0
4.0-7.0
< 4.0

Insulin dose (mls/hour)


7
6
5
4
3
2
1
Treat for Hypoglycaemia following Hypoglycaemia

treatment protocol
4. Target Blood Glucose is 5.0 -10.0 mmol/l
-Measure and chart blood glucose hourly for 6 hours adjusting insulin infusion rate as appropriate.
-If after 6 hours, blood glucose is stable (at target of 5.0 -10.0 mmol/l), then test every 2-3 hours
Transition from Intravenous Insulin therapy to subcutaneous insulin therapy
(a)This should be done when patient is eating and drinking.
(b) 2 to 3 hours before the planned time to stop Intravenous Insulin therapy, give intermediate insulin (NPH) or
long-acting insulin (Insulin Glargine AKA Lantus)
30 minutes before the planned time to stop Intravenous Insulin therapy, give short-acting insulin(Actrapid) or
rapid-acting insulin(Humalog).
(d) Initial doses of subcutaneous Insulin are based on:
(i)Previously established dose requirements
(ii)Previous experience for the patient under similar circumstances of Nutritional change
(iii)Stability or Instability of Medical condition and nutritional intake
(iv)Insulin requirements during Intravenous Insulin therapy
_____________________
Endosed for adoption by:
Dr. Hans van Zyl
Hospital Superintendent

Date: 16th May 2013