EPIC dot phrase for insulin infusion protocol
Assess insulin resistance:
Sensitive: >70YO, GFR<45, no hx of diabetes***
Resistant: BMI>35, Home insulin >80 U/day, Steroid >20 mg/day prednisone***
Select starting dose:
Sensitive/Regular/Resistant***
181-220: 2/3/4***
221-260: 3/4/5***
261-300: 4/6/8***
301-350: 5/8/10***
>350: 6/10/12***
^^for physician reference only, use then delete***
Start infusion at *** unit/hr. Follow insulin titration based on FSBG below to a max infusion rate of 20 units/hr.
FSBG <41 mg/dL:
-Give 25 g D50 VP (50 ml) STAT
-Notify provider, Complete: “Glucose Critical Value RN care plan note”
-HOLD infusion. When BG >180 mg/dL, restart infusion at 50% of prior rate
-Check BG q 15 minutes x 4, then q hour
FSBG: 41-69 mg/dL:
-Give 12.5 g D50 IVP (25 mL)
-Notify provider, Complete “Glucose Critical Value RN care plan note”
-HOLD infusion. When BG >180 mg/dL, restart infusion at 50% of prior rate
-Check BG q 15 minutes x 2, then q 1hour
FSBG 70-100:
-HOLD infusion. When BG >180 mg/dL, restart infusion at 50% of prior rate
-Check BG q30min until BG is >110 mg/dL. Check BG q1hr thereafter.
FSBG 101-109:
-If BG is increased from prior measurement or decreased by 0-30 mg/dL: reduce infusion rate by 50%.
-If BG has decreased from prior measurement by >30 mg/dL: HOLD infusion. When BG >180 mg/dL, restart infusion at 50% of prior rate.
-Check BG in 1 hour.
FSBG 110-140:
-If BG is increased from prior measurement or decreased by 0-30 mg/dL: continue infusion at the same rate.
-If BG has decreased by >30 mg/dL: reduce infusion rate by 50%.
-Check BG in 1 hour.
FSBS is 141-180:
-No change in insulin infusion rate.
-May go to q 2 hours after 6 hrs of glucose within this range. If BG is greater than 25 mg/dL lower than previous BG, check BG in 1 hr.
FSBS is 181-210:
-If BG is increased from prior measurement or decreased by 0-30 mg/dL: increase infusion rate by 1 unit/hr.
-If BG has decreased from prior measurement by >30 mg/dL: continue infusion at the same rate.
-Check BG in 1 hour.
FSBS is 211-240:
-If BG is increased from prior measurement or decreased by 0-30 mg/dL: increase infusion rate by 2 unit/hr.
-If BG has decreased from prior measurement by >30 mg/dL: continue infusion at the same rate.
-Check BG in 1 hour.
FSBS is >240:
-If BG is increased from prior measurement or decreased by 0-30 mg/dL: increase infusion rate by 3 unit/hr.
-If BG has decreased from prior measurement by >30 mg/dL: continue infusion at the same rate.
-Check BG in 1 hour.
-Notify provider if 3 consecutive BG >240 mg/dL.
**Critical Laboratory Values are: BG <= 50 mg/dL and BG >= 500 mg/dL
Consider Endocrinology consult (if available) for patients requiring greater than 20 units per hour of insulin