Stopping Insulin Infusion:

Evidence Based Practice:

BGL 140-180 mg/dL (Cardiac Surgery Pt 160-180 mg/dL) over 12

consecutive hrs or < 1 unit/hr
RN notify HCP
Transition to alternative insulin
management
HCP must provide written
authorization to D/C
Cardiac Surgery Pts should maintain 140-160 mg/dL for first 24 hrs

Optimal BG target range unclear for

critically ill Pt but research
shows BG >180 should be
treated with insulin drip
Adjustments should be done according to blood glucose readings

Hourly checks are essential in adjusting insulin infusion

Nurse led IV insulin protocol with
conservative blood glucose target is effective and safe in ICU
Pts
Reduction in hypoglycemic events

Hyperglycemia: high blood glucose from body has to little insulin

or body can not use the insulin
properly
Causes: Stress, illness, corticosteroids, too much food, little/no
diabetic medication, poor absorption of insulin, inactivity, Dawn
phenomenon
S/S: elevated blood glucose, polydipsia, polyuria, polyphagia,
blurred vision, weakness, wt loss,
syncope, glycosuria, N/V, abd
cramps, fatigue, HA, progression to
DKA or HHS
References
American Diabetes Association
The Joint Commission.
Critical Care Nurse
St. Louis, Mo.: Elsevier/Mosby.

Decrease in length of stay in ICU

and step down units
Protocols assist nurse/physicians in
safely targeting BGL in ICU
and improve standardization
and optimization of continuous
IV insulin administration

Hospital National Patient Safety

Goals NPSG.02.02.01

Improve communication
Report critical results/timely
basis

Pt treated promptly

Develop written procedures to

manage critical results/
diagnostics

INSULIN
DRIP
PRESENTED BY:
MARY-ELIZABETH CASTER
ELIZABETH FLYNN
BRENDA WHEELER

Upstate Insulin Drip

Policy Outline*

Admitted to the ICU-BGL via

Glucometer upon admission
and q6h for 24h for hyperglycemia monitoring/mgt
Post-operative cardiac surgery patients-BGL via Glucometer upon admission and
q2h for 24h after anesthesia
for hyperglycemia monitoring/mgt
Notification of elevated BGL
reported to HCP by the RN as
described in Section AHyperglycemia Triage Algorithm
Any whole blood glucose
>400 mg/dL or<70 mg/dL
verify by serum blood glucose
BGL >400 mg/dL or <70 mg/
dL verified by serum blood
glucose measurement
Patients unable to reach/
maintain target levels of 140
-180 mg/dL(140-160 mg/dL
Cardiac Surgery Patients) using chart Section B will have
insulin dose regulated and
prescribed individually by
the HCP
Notify HCP anytime Insulin
drip turned off
Non-diabetic BGL 180250mg/dL
Non-diabetic BGL >250mg/dL
Diabetic or Cardiac Surgery
Pt. >/= 160mg/dL
Anion Gap >/= 16
For bolus and drip, Insulin
Regular

*This is not the full policy. Refer to

actual policy before administering
insulin IV drip.

Drip Initiation Chart Table 1 Insulin Bolus Chart

Blood Glucose (mg/
dL)

Regular
Insulin IV
bolus

Regular
Insulin
(IV infusion/hour)

181-200

No Bolus

201-250

Cardiac Surgery Pts Only

Blood Glucose (mg/dL)

Regular Insulin
IV Bolus

Regular Insulin
(IV infusion/
hour)

2 units

160-200 CARDIAC SURGERY PATIENTS ONLY*

2 Units

2 Units

3 Units IV

2 Units

201-250

3 Units IV

2 Units

251-300

6 Units IV

3 Units

251-300

6 Units IV

3 Units

301-350

9 Units IV

3 Units

301-350

9 Units IV

3 Units

>350

10 Units IV

4 Units

>350

10 Units IV

4 Units

Table II Dose Adjustment Charts

<70

Hold Insulin Drip and notify HCP. Give 25 Grams D50% Glucose. Check BG Q30 minutes and notify HCP of each result.

70-100

Hold Insulin Drip and notify HCP Recheck BG in 15 minutes and notify HCP of result. If still 70-100, give 12.5 Grams of
50% Dextrose and check BG every 30 minutes and notify HCP of each result until insulin drip is restarted or the HCP orders otherwise. When >140mg/dL restart drip at 50% previous state.
Previous Blood Glucose (mg/dL)

Current BG mg/dL

<100

100140

101-140

rate by
1unit/hr

rate by 25% or 0.5units/

hr**

141-180
(141-160 CardiacSurg Pts)

No Change

181-200
(161-200 CardiacSurg Pts***)

rate by
1unit/hr

201-250

251-300

141-180 (141160 Cardiac

Surgery Pts)

201-250

251300

rate by 50% or 2 units/hr**

301-400

>400

rate by 75% or
2units/hr**

rate by 50% or 2units/hr**

rate 0.5units/hr

rate by 25% 2units/hr**

rate by 25% or
2.5units/hr**

181-200
(161-200 Cardiac Surgery Pts)

rate by 25% or
1/unit/hr**

No Change

rate by 25% or
2units/hr**

rate by 25% or 1 unit/hr**

rate by 25%
or 1.5units/
hr**

rate by 25% or
1unit/hr**

rate
1unit/hr

301-350

rate by 25% or 3units/hr**

351-400

rate by 50% or 4units/hr**

rate
by
1.5uni
ts/hr

rate
by
1unit/hr

No
Change

rate by
25% or
2units/
hr**

No
Change

** Whichever is greater change *** Cardiac Surgery Pt whenever BG >= 160 in first 24hr, call HCP for extra boluses or adjustments