Insulin used for infusion: insulin aspart (Novo Nordisk)
Desirable blood glucose range: 80 to 110 mg/dL
Admission protocol:
(1) Measure blood glucose on admission to the ICU.
(2) Start an intravenous infusion:
(2a) If the blood glucose is < 110 mg/dL, then do not add insulin.
(2b) If the blood glucose is 110 to 200 mg/dL, then start insulin at a dose of 1-3 IU per hour.
(2c) If the blood glucose is > 200, then start insulin at a dose of 4-5 IU per hour.
Ongoing protocol:
(1) Measure blood glucose:
(1a) If the admission blood glucose was normal, then measure every 4 hours.
(1b) If the admission blood glucose was elevated, then measure every 1 to 2 hours until target range achieved.
(2) Adjust the intravenous infusion:
(2a) If the blood glucose is < 110 mg/dL, then do not change insulin.
(2b) If the blood glucose is 110 to 200 mg/dL, then increase the insulin dose by 0.5-1.0 IU per hour.
(2c) If the blood glucose is > 200 mg/dL, then increase the insulin dose by 1-2 IU per hour.
Handling hypoglycemia:
(1) If the blood glucose drops sharply then (a) reduce insulin dose by 50% and (b) measure glucose in 1 hour.
(2) If the blood glucose is 60 to 80 mg/dL then reduce the insulin dose by 0.5 IU per hour.
(3) If the blood glucose is 40 to 60 mg/dL, then (a) stop the insulin infusion, (b) provide adequate glucose intake, and (c) measure blood glucose in 1 hour.
(4) If the blood glucose is < 40 mg/dL, then (a) stop the insulin infusion, (b) give 30 mL of 33% glucose and (c) measure blood glucose in 1 hour.
