Thursday March 16, 2006
IV insulin dose
As ICUs are moving more and more towards protocol based orders, insulin drip protocol remains one of the most sought protocol. There is no proven formula available for the dose of insulin drip but one 'rule of thumb' available is as follows:
(Current Blood Glucose - 60) x multiplier = number of units of insulin/hour
Multiplier could range anywhere from .01 to .09 depending on level of glucose control required. Practically, start multiplier from .01/.02 and continue to escalate till desired control achieved. Control can be made tighter as needed with blood glucose level at given point. Like patient with blood sugar of 359 may start with as low as (359-60) x .01 = 3 units/hour but depending on further blood glucose level may require upto (359-60) x .09 = 27 units/hour of insulin.
The best precise article we found with all insulin related protocols is Hospital management of diabetes: Beyond the sliding scale written by Dr. Etie Moghissi, Co-chair, American College of Endocrinology Task Force on Inpatient Diabetes and Metabolic Control. ( Reference: CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 71 • NUMBER 10 OCTOBER 2004. Page 801).