INSULIN DRIPS

Overview

Insulin infusions are commonly seen in the ICU in DKA, post-surgical, and critically ill
patients. It is used to quickly decrease blood sugar levels in a very controlled
environment.

Nursing Points

General

I. Insulin infusion

A. Understand WHY the patient needs it

A. DKA

B. Post-surgical

C. Critically ill

II. When initiating the infusion

A. Follow your facility’s protocols

B. Know the target blood glucose

C. Insulin infusion is weight-based

III. When starting the infusion

A. Obtain a blood glucose

B. If it is greater than 160 then start the insulin infusion at (kg x 0.025 units)=
units per hour

C. 70 kg x 0.025 units = 1.75 units /hour

D. Recheck blood glucose in 1 hour

E. Depending on the results and the protocol either titrate insulin up or down
 F. D5 NS to infuse in a separate line depending on blood glucose level

IV. Nursing considerations

A. Monitor blood glucose every hour while on an insulin infusion

B. Monitor for s/s of hypoglycemia

C. Do not decrease blood sugar too rapidly

D. Monitor potassium

A. IV insulin can push potassium into cells decreasing serum

potassium

B. Hyperkalemia is treated with IV insulin

Assessment

I. Insulin infusion

I. Understand WHY the patient needs it

A. DKA

1. Rapid onset

2. Easily titratable

B. Critically Ill or post-surgical patient

1. Elevated blood glucose levels can compromise

healing/outcome

2. Know the patient’s glucose baseline

3. A1C

II. When initiating the infusion

I. Follow facility protocols

II. Know the target blood glucose

 B. When starting the infusion

I. Obtain a blood glucose

A.

A. If it is greater than 160 then start the insulin infusion at (kg x 0.025 units)=
units per hour

1. 70 kg x 0.025 units = 1.75 units /hour

B. Recheck blood glucose in 1 hour

1. Depending on the results and the protocol either titrate insulin up or

down

C. D5 NS to infuse in a separate line depending on blood glucose level

B.  IV. Nursing considerations

A.

1.

A. Monitor blood glucose every hour while on an insulin infusion

B. Monitor for s/s of hypoglycemia

C. Do not decrease blood sugar too rapidly

D. Monitor potassium

1. IV insulin can push potassium into cells decreasing

serum potassium

2. Hyperkalemia is treated with IV insulin

Nursing Concepts

I. Glucose metabolism

II. Acid Base balance

III. Clinical judgement