Endocrinology Book


Variable Rate Insulin Infusion

Aka: Variable Rate Insulin Infusion, Insulin Infusion, Insulin Drip
  1. See Also
    1. Hourly Subcutaneous Insulin Lispro
  2. Indications
    1. Patient not eating (e.g. post-operative)
  3. Preparation
    1. Regular Insulin 100 units in 100 cc NS (1 u per 1 ml)
  4. Protocol: Insulin Infusion
    1. Starting dose of Insulin Infusion
      1. Type I Diabetic: 0.5 to 1 unit per hour
      2. Type II Diabetic or poor control: 2-3 units per hour
      3. Weight-based (use true weight, not Ideal Weight)
        1. Diabetic Ketoacidosis: 0.1 Units/kg/h
        2. Non-ketotic: 0.05 Units/kg/h
          1. Consider starting with this dose in very large patients with high calculated doses
    2. Insulin bolus prior to starting Insulin Drip is controversial
      1. Not recommended in pediatric patients
      2. Use in adult Diabetic Ketoacidosis does not offer additional benefit over Insulin Infusion alone
        1. Goval (2010) J Emerg Med 38(4): 422-7 [PubMed]
      3. Insulin bolus dosing in Diabetic Ketoacidosis if used (adults only)
        1. Bolus Insulin dose: 10 units
    3. Coadminister D5W at 100 to 125 cc per hour
    4. Check Blood Glucose every 30 minutes to 1 hour
      1. Glucose <70 Then
        1. Turn off Insulin Drip for 30 minutes
        2. Blood Glucose on recheck still <70
          1. Give 25 ml of D50 IV (or 10-12 grams Glucose)
        3. Recheck Blood Glucose every 30 minutes
          1. Restart infusion when Glucose >100 mg/dl
          2. Decrease Insulin Drip rate by 1.0 u/h
      2. Glucose 71-120 Then
        1. Decrease Insulin Drip by 1.0 u/hour
      3. Glucose 121-180 Then
        1. No change
      4. Glucose 181-250 Then
        1. Increase Insulin Drip by 2 units/hour
      5. Glucose 251-300 Then
        1. Increase Insulin Drip by 3 units/hour
      6. Glucose 301-350 Then
        1. Increase Insulin Drip by 4 units/hour
      7. Glucose 351-400 Then
        1. Increase Insulin Drip by 5 units/hour
      8. Glucose >400 Then
        1. Increase Insulin Drip by 6 units/hour
    5. IF Insulin Drip drops to 0 units/hour
      1. Continue q2 hour Blood Glucose Monitoring
      2. Restart Insulin Drip when Blood Glucose >150
  5. Discontinuation (e.g. Postoperatively)
    1. Administer patient's usual Insulin dose pre-meal
    2. Patient eats meal
    3. Discontinue Insulin Infusion two hours after meal
  6. References
    1. Marks (2003) Am Fam Physician 67(1):93-100 [PubMed]

Insulin (C0021641)

Definition (NCI) A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
Definition (NCI) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism.
Definition (CSP) protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose and is also an important regulator of protein and lipid metabolism; insulin is used as a drug to control insulin-dependent diabetes mellitus.
Definition (MSH) A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH D007328
SnomedCT 325014006, 67866001, 39487003, 412222002
LNC LP70329-5, LP16325-0, LP14676-8, LP32542-0, MTHU002108, MTHU019392, LA15805-7
English Insulin, insulin, Regular Insulin, Soluble insulin, Insulin Regular, insulin preparations, insulin preparations (medication), insulin regular, Insulin [Chemical/Ingredient], insulin products, insulin preparation, insulin product, regular insulin, insulins, Insulin, Soluble, Soluble Insulin, Soluble insulin (substance), Insulin regular, Insulin, Regular, Insulin product, Insulin (substance), Insulin preparation, Insulin product (product), Regular insulin product, Unmodified insulin product, Insulin preparation, NOS, Regular insulin preparation, Unmodified insulin preparation, Insulin preparation (substance), Regular insulin (substance), Regular insulin, INSULIN
Swedish Insulin
Finnish Insuliini
French Insuline ordinaire, Insuline soluble, Insuline
Spanish producto con insulina (producto), preparado insulínico, insulina (producto), producto con insulina, insulina (sustancia), insulina, preparado de insulina (producto), preparado de insulina (sustancia), preparado de insulina cristalina de cinc, preparado de insulina cristalina de zinc, preparado de insulina no modificada, preparado de insulina, insulina regular (sustancia), insulina regular, Insulina
Italian Insulina regolare, Insulina
Croatian INZULIN
Polish Insulina
Japanese インスリン, インスリン亜鉛水性懸濁液, インシュリン
Czech inzulin, insulin
Norwegian Insulin, Oppløselig insulin
German Insulin
Portuguese Insulina
Derived from the NIH UMLS (Unified Medical Language System)

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