Holzinger et al used an insulin infusion protocol to control blood glucose for patients in the medical intensive care unit (ICU). This was based on the protocol of van den Berghe. The authors are from the General Hospital and Medical University of Vienna.
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.
Purpose: To control blood glucose in the medical intensive care unit (ICU) using the insulin infusion protocol of Holzinger et al.
Specialty: Endocrinology, Clinical Laboratory
Objective: administration
ICD-10: R73.9, ,