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Wisconsin Insulin Infusion (Standard Dose) – Adult – Practice Protocol

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


Wisconsin Insulin Infusion (STANDARD DOSE) - Adult - Practice Protocol
Last Updated February 2016
Column 7-9
Only for use
in ICUs
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.
Glucose Monitoring Orders
Perform blood glucose monitoring 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.
Initiating the Infusion (NOTE: After priming IV tubing, waste additional 20 mL of insulin to saturate all tubing binding sites.)
Column 1: Only start here for extremely insulin sensitive patients
(i.e., patients with type 1 diabetes using less than 30 units insulin/day at home or s/p islet transplant)
Column 2: Start here for most patients. (Note exceptions for Column 1 or 3)
Column 3: Start here if patient meets at least 1 of the following conditions: glucose level ≥ 600 mg/dL; s/p cardiac surgery or solid organ transplant
(this admission); receiving vasopressors such as epinephrine, norepinephrine, vasopressin OR steroids such as prednisone, dexamethasone,
methylprednisolone, hydrocortisone; history of diabetes using ≥ 80 units/day of insulin as an outpatient
Columns 4-6: Do Not Start Here.
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.

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 already using Column 1, follow dosing parameters as written in Column 1).
Column 1 Column 2 Column 3 Column 4 Column 5 Column 6
BG Units/hr BG Units/hr BG Units/hr BG Units/hr BG Units/hr BG Units/hr
≥360 3 ≥360 6 ≥360 12 ≥360 18 ≥360 26 ≥360 30
330-359 2.5 330-359 4 330-359 9 330-359 15 330-359 24 330-359 30
300-329 2 300-329 4 300-329 8 300-329 13 300-329 22 300-329 28
270-299 1.8 270-299 3 270-299 7 270-299 11 270-299 18 270-299 28
240-269 1.5 240-269 3 240-269 6 240-269 10 240-269 14 240-269 24
210-239 1 210-239 2 210-239 5 210-239 8 210-239 12 210-239 20
180-209 1 180-209 2 180-209 4 180-209 6 180-209 10 180-209 16
151-179 0.8 151-179 1.5 151-179 3 151-179 5 151-179 9 151-179 12
T
ar
ge
t
Ra
ng
e
140-150 0.5 140-150 1.2 140-150 2.5 140-150 4 140-150 8 140-150 10
130-139 0.3 130-139 1 130-139 2 130-139 3 130-139 5 130-139 8
110-129 0.2 110-129 0.8 110-129 1.5 110-129 2.5 110-129 4 110-129 6
89-109 OFF BG less than 110 mg/dL : Move left 1 column every hour until BG is back within Target Range
Check BG hourly,
resume infusion
100-109 0.5 100-109 1 100-109 1.5 100-109 2 100-109 4
90-99 0.2 90-99 0.5 90-99 1 90-99 1.5 90-99 3
when BG >109mg/dL 70-89 0.2 70-89 0.2 70-89 1 70-89 1 70-89 1.5
<70 OFF <70 OFF <70 OFF <70 OFF <70 OFF <70 OFF
BG less than 70 mg/dL = hypoglycemia (see below 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
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016CCKM@uwhealth.org