Intravenous Insulin Protocol: Non-Cardiac Surgery

         Standard insulin concentration is 1 U regular insulin per 10 mL saline

         Tubing should be flushed with 50 mL or beofre use for either a 250 or 500 mL bag

         CBG is measured hourly for 6-8 hrs and until stable; then every 2 hrs thereafter

         Initial rates would be 1U/hr for Type II patients and men with Type I diabetes; women with Type I diabetes may be started at 0.5 U/hr

Algorithm:

Capillary Glucose                                           Action

<70 mg/dL                                                       discontinue infusion for 30 min.

Administer 15-20 ml 50% dextrose;

remeasure glucose in 30 min and

restart insulin infusion at 1U/hr after

blook glucose >100mg/dL;

continue glucose infusion.

70-120 mg/dL                                                  decrease rate by 0.3 U/hr

121-180 mg/dL                                                no change

181-240 mg/dL                                                increase by 0.3 U/hr

241-300 mg/dL                                                increase by 0.6 U/hr

over 300 mg/dL                                               increase by 1U/hr

Most adults require a minimum of 10 gm glucose/hr and additional potassium chloride;

10% glucose in 0.45% sodium chloride with 20mEq/L KC1 at 100 ml/hr may be infused

separate to the insulin infusion.

Urinary ketones should be measure every 24 hrs.

Initial Regular Insulin Rate for Diabetic Patients Undergoing CABG

BG (mg/dL)                              20-30                    31-50                    51-70                    71-90                    91-120           

<80*

>80                                     0.2                   0.4                   0.6                   0.8                    1.0

>120                                   0.6                   1.0                   1.5                   2.0                    2.4

>180                                   1.3                   2.0                   3.8                   4.6                    5.4

>240                                   2.0                   3.0                   3.8                   4.6                    5.4

>300                                   3.0                   4.0                   5.0                   6.0                    7.0

*When CBG is <80 mg/dL, stop the insulin infusion, continue dextrose infusion and recheck