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Wisconsin Insulin Infusion (High Dose) - Adult - Practice Protocol (ICU only)

Wisconsin Insulin Infusion (High Dose) - Adult - Practice Protocol (ICU only) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Practice Protocols, Related


Wisconsin Insulin Infusion (HIGH DOSE) - Adult - Practice Protocol (ICU ONLY)
Last Updated February 2016
Glucose Monitoring Orders
Perform Blood Glucose Monitoring (bedside) every hour until within Target Range (110-150 mg/dL) for
3 hours (3 readings in a row), then decrease frequency to every 2 hours. Hourly monitoring must be
resumed if blood glucose deviates from Target Range. Serum monitoring only for patients with Hct<20%,
compromised circulation, and any other conditions specified in Policy 11.26.
Rules for the Use of Columns 7-9:
 A patient must be in the ICU to use the HIGH DOSE columns 7-9. If criteria are met to move into column 7 for general care/IMC
patient currently in Column 6, notify provider/ DMS to determine if SC insulin could be added or if ICU transfer is warranted.
 A patient must be using Column 6 and meet criteria to move right 1 column in order to transition to Column 7.
 When criteria are met to move left 1 column for a patient using Column 7, patient should be moved back to Column 6 of the STANDARD
DOSE Insulin Infusion Protocol.
Rules for Making Rate and Column Changes
1. Determine the amount of change in blood glucose since the
previous glucose check; follow decision tree below.
2. Do not move more than one column each hour unless
specifically ordered.
3. Nutritional Considerations: If SQ rapid-acting insulin
(aspart/lispro) is administered with meals, stay in the same column
for the next 2 hours; continue to adjust rate based on hourly BG
checks. Two hours after SQ insulin is given, resume use of
decision tree below.
4. Consider moving right after initiation or increase of vasopressors
or steroids (including epinephrine, norepinephrine, vasopressin,
prednisone, dexamethasone, methylprednisolone, and/or
hydrocortisone), tube feeding or TPN if BG values increase with
subsequent monitoring.
5. Consider moving left after reduction or discontinuation of
medications (as above), tube feeding or TPN, or 2-4 hours after
giving 1st dose of subcutaneous basal insulin (i.e., glargine) if BG
values decrease with subsequent monitoring.
Column 7 Column 8 Column 9
BG Units/hr BG Unit/hr BG Units/hr
>360 38 >360 46 >360 54
330-359 36 330-359 42 330-359 48
300-329 34 300-329 38 300-329 44
270-299 30 270-299 34 270-299 38
240-269 26 240-269 30 240-269 34
210-239 22 210-239 26 210-239 30
180-209 18 180-209 22 180-209 26
151-179 15 150-179 18 150-179 22
T
ar
ge
t
Ra
ng
e 140-150 12 140-149 15 140-149 18
130-139 10 130-139 12 130-139 15
110-129 8 110-129 10 110-129 12
BG less than 110 mg/dL : Move left 1 column every hour until BG is back
within Target Range; revert to columns 1-6 as needed
100-109 5 100-109 6 100-109 8
90-99 4 90-99 5 90-99 7
70-89 3 70-89 3 70-89 5
<70 Off <70 Off <70 Off
BG less than 70 mg/dL = hypoglycemia
(see right for Hypoglycemia Management)
Amount of Change
> 100 mg/dL
In Target
Below
Target
Above
Target
BG 70-109 mg/dL
Move left one
column;
Adjust rate
Stay in same
column;
Adjust rate
1st time: Stay
in same
column;
Adjust rate
2nd
consecutive
occurrence:
Move right
one column;
Adjust rate
If BG is
increasing,
move right
one column;
adjust rate
Amount of Change
50 – 100 mg/dL
In Target
Below
Target
Above
Target
BG 70-109 mg/dL
Move left one
column;
Adjust rate
Stay in same
column;
Adjust rateBG< 70 mg/dL
Turn off, follow
Hypoglycemia
orders
Stay in same
column;
Adjust rateBG< 70 mg/dL
Turn off,
follow
Hypoglycemia
orders
If BG is
decreasing,
move left
one column;
adjust rate
Amount of Change
0 – 49 mg/dL
Hypoglycemia Management (BG <70 mg/dL)
STEP 1: Stop infusion. (Infusion should be off for at
least 30 minutes; See step 4, below, for how
to re-start).
STEP 2: Provide treatment as ordered.
STEP 3: Recheck glucose within 15 minutes after
treatment. Repeat treatment as ordered until
BG ≥ 70 mg/dL. Another BG will need to be
checked before re-starting infusion.
STEP 4: Re-start infusion if insulin has been off for
30 minutes AND if current BG is 110
mg/dL or greater. Move Left 1 column and
restart infusion rate according to current
glucose value (**If hypoglycemia occurred
while patient was in Column 7, move to
Column 6 of STANDARD Insulin Infusion
Protocol when time to re-start.)
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org