SOUTHWEST WASHINGTON MEDICAL CENTER

VANCOUVER, WASHINGTON

PRE-PRINTED ORDER

CRITICAL CARE ADULT INSULIN INFUSION PATIENT LABEL

111.P45 Revised 7/20/06 Approved 6/3/05
MEDICINE
_________________________________________________________
Page 1 of 1. Please write firmly with a ball-point pen.
Orders with ‰ must be checked to initiate.
*3ORD*
3ORD
All other orders in effect unless crossed out.

General guidelines: Goal Blood Glucose 80-110

• Initiate insulin if capillary blood glucose > 180 or 2 consecutive blood glucose > 140
st
• Insulin infusions should be discontinued when patient is eating and 1 hr after receiving 1 dose of maintenance
subcutaneous insulin.
KEYNOTE: If patient remains on insulin infusion while eating meals, the patient requires pre-meal subcutaneous
insulin (see guidelines on backer). Do not adjust infusion within 3 hours after the meal.
• Discontinue Critical Care insulin infusion orders prior to transfer from Critical Care and contact provider for further orders
Diagnostics/Patient Monitoring:
• Nutrition Profile daily
• Check capillary BG every hour until within goal range x 3 hours, then decrease to every 2 hours
Intravenous Fluids:
• Standard insulin drip: 50 units/500 mL 0.9% NaCl (1 unit/10 mL) via an infusion device
• Start intravenous infusion with dextrose once capillary BG is less than 300mg/dl (most patients will need 5-10gm of
glucose per hour – for example, as provided by a 5% dextrose solution at 125mL/hr) (Check one box)
‰ D5NS with _______mEq KCl/L @_________mL/hour
‰ D51/2NS with _______mEq KCl/L @_________mL/hour
‰ Other ______________________________________________________________________________
Initiating the Infusion:
‰ Algorithm 1: most patients start here
‰ Algorithm 2: for patients not controlled with algorithm 1, s/p CABG, receiving glucocorticoids, or patients with diabetes
receiving more than 80 units of insulin per day as an outpatient.

ADULT ORDER SHEET

.
Algorithm 1 Algorithm 2 Algorithm 3 Algorithm 4 Algorithm 5 Algorithm 6
BG Units/hr BG Units/hr BG Units/hr BG Units/hr BG Units/hr BG Units/hr
BG less than 60 = hypoglycemia (see below for treatment)
<70 0ff <70 0ff <70 0ff <70 0ff <70 0ff <70 0ff
70-89 0.2 70-89 0.5 70-89 1 70-89 1.5 70-89 2 70-89 3
90-99 0.5 90-99 1 90-99 1.5 90-99 2 90-99 3 90-99 5
100-109 1 100-109 1.5 100-109 2 100-109 3 100-109 4 100-109 6
110-129 1 110-129 2 110-129 3 110-129 4 110-129 5 110-129 8
130-149 1.5 130-149 2.5 130-149 4 130-149 6 130-149 7 130-149 10
150-179 1.5 150-179 3 150-179 5 150-179 7 150-179 9 150-179 12
180-209 2 180-209 4 180-209 6 180-209 9 180-209 12 180-209 16
210-239 2 210-239 5 210-239 7 210-239 11 210-239 14 210-239 20
240-269 3 240-269 6 240-269 9 240-269 13 240-269 17 240-269 24
270-299 3 270-299 7 270-299 10 270-299 16 270-299 20 270-299 28
300-329 4 300-329 8 300-329 12 300-329 20 300-329 24 300-329 32
330-359 4 330-359 9 330-359 14 330-359 24 330-359 28 330-359 36
>360 6 >360 12 >360 16 >360 28 >360 32 >360 40
Adjusting the infusion:
• If patient remains in goal range there is no need to adjust rate unless BG falls out of goal range.
• Decrease insulin infusion rate by 50% if nutritional therapy (e.g. TPN or tube feeds) is discontinued or significantly
reduced, and reinstate hourly BG checks x 3 hours, then BG checks every 2 hours
Moving from Algorithm to Algorithm:
• Moving Right: If BG < 200 – an algorithm failure is defined as BG outside the goal range and BG has not decreased
If BG > 200 – an algorithm failure is defined as BG outside the goal range and BG has not decreased by
at least 60 mg/dL within 1 hour
• Moving Left: When BG is < 70 mg/dL x 2 or if BG decreases by > 100 mg/dL in one hour
• Contact provider if BG not controlled with Algorithm 6
Hypoglycemia (capillary BG < 60 mg/dL):
• Discontinue insulin infusion
• Give D50W IV 25 mL and recheck BG in 15 minutes and repeat 25 mL of D50W if BG still < 60 mg/dL
• Notify physician of all episodes of hypoglycemia and obtain further orders regarding insulin infusion
• Resume insulin infusion once BG > 80 and move 1 algorithm to the left
Date Time Physician/Provider Signature
 BACKER FOR 111.P45
REVISED 7/20/06 APPROVED 2/27/06

CRITICAL CARE ADULT INSULIN INFUSION

Subcutaneous insulin dosing guidelines for patients who are eating but remain on the
insulin infusion:

Proportion of Meal Consumed Subcutaneous Insulin Dose

(Regular or Aspart (Novolog®))
Less than 50% 3 units
More than 50% 6 units

• Regular insulin should be given 30 minutes before the meal

• Insulin aspart (Novolog®) should be given 10 minutes or less before the meal (or
sometimes shortly after the meal if intake is uncertain)