Editorial
Copyright ©2014 Baishideng Publishing Group Co.
World J Anesthesiol. Mar 27, 2014; 3(1): 1-11
Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.1
Table 2 Continuous insulin infusion protocol
Initiating CII:
Prepare solution: 1 unit per 1 mL of 0.9% normal saline
Start CII when blood glucose level ≥ 140 mg/dL (x 2)
Patients with known diabetes treated with insulin can start CII when blood glucose ≥ 70 mg/dL
Initial rate: divide blood glucose level (mg/dL) by 100, then round to nearest 0.5 UI
Insulin infusion rate change:
BG (mg/dL) instructions:
> 200 ↑ rate by 2 UI/h
> 160-200 ↑ rate by 1.0 UI/h
> 120-160 ↑ rate by 0.5 UI/h
80-120 No change in rate
60-80 If < 10% lower BG, rate by 1 UI/h
Check BG within 30 min
If > 10% lower BG, 2 rate by 50%
Check BG within 30 min
< 60 Stop infusion (give IV dextrose 12.5 g IV bolus)
Check BG within 30 min. When BG > 100 mg/dL, restart infusion at 50% of previous rate
Patient monitoring:
Check capillary blood glucose every hour until it is within goal range for 2 h, and then decrease to every 2 h
Hourly monitoring may be indicated for critically ill patients even if they have stable blood glucose
If a patient is eating, hourly blood glucose monitoring is necessary for at least 3 h after eating
Decrease insulin infusion rate by 50% if nutritional therapy (e.g., total parenteral nutrition or tube feeds) are discontinued or significantly reduced