What is the recommended frequency for administering regular insulin (insulin) intravenous pushes for hyperglycemia?

Regular Insulin Administration for Hyperglycemia

For hyperglycemia management in hospitalized patients, regular insulin can be administered subcutaneously every 4-6 hours as needed for blood glucose correction. 1

Insulin Administration Protocol Based on Clinical Setting

For Non-DKA Hyperglycemia in Hospitalized Patients:

• Regular insulin can be administered subcutaneously every 6 hours for hyperglycemia correction 1
• Rapid-acting insulin analogs can be administered every 4 hours as an alternative 1
• In adult patients who are NPO (nothing by mouth), supplemental subcutaneous regular insulin can be given in 5-unit increments for every 50 mg/dl increase in blood glucose above 150 mg/dl, up to 20 units for blood glucose of 300 mg/dl 1

For Patients on Enteral/Parenteral Nutrition:

• For continuous enteral feedings: Regular insulin every 6 hours or rapid-acting insulin every 4 hours for hyperglycemia 1
• For bolus enteral feedings: Regular insulin every 6 hours or rapid-acting insulin every 4 hours for hyperglycemia 1
• For parenteral feedings: Regular insulin every 6 hours or rapid-acting insulin every 4 hours for hyperglycemia 1

For Mild DKA:

• Initial "priming" dose of regular insulin of 0.4–0.6 units/kg body weight (half as IV bolus, half as subcutaneous or intramuscular injection) 1
• Followed by 0.1 unit/kg regular insulin subcutaneously or intramuscularly every hour 1
• Regular insulin given subcutaneously or intramuscularly every hour is as effective as intravenous administration in lowering blood glucose and ketone bodies in mild DKA 1

For Moderate to Severe DKA:

• Continuous intravenous insulin infusion is the preferred treatment rather than intermittent insulin pushes 1
• Initial IV bolus of regular insulin at 0.15 units/kg body weight, followed by continuous infusion at 0.1 unit/kg/hour (approximately 5-7 units/hour in adults) 1

Monitoring and Adjustments

• Blood should be drawn every 2-4 hours for determination of serum electrolytes, glucose, blood urea nitrogen, creatinine, osmolality, and venous pH (for DKA) 1
• Criteria for resolution of DKA includes glucose <200 mg/dl, serum bicarbonate ≥18 mEq/l, and venous pH of ≥7.3 1
• Once DKA is resolved, if patient remains NPO, continue IV insulin and supplement with subcutaneous regular insulin every 4 hours as needed 1

Important Considerations and Pitfalls

• Basal-bolus insulin regimens (with both long-acting and short-acting insulin) are superior to sliding scale insulin alone for inpatient glycemic control 1, 2
• Abrupt discontinuation of intravenous insulin coupled with delayed onset of subcutaneous regimen can lead to poor glycemic control 1
• When transitioning from IV to subcutaneous insulin, continue IV insulin infusion for 1-2 hours after starting the subcutaneous regimen to ensure adequate plasma insulin levels 1
• The pharmacokinetics of regular insulin differ significantly between IV and subcutaneous routes, with IV administration resulting in higher serum insulin levels and faster clearance 3
• Hypoglycemia risk increases with frequent insulin administration, so careful monitoring is essential 2, 4

Transition to Maintenance Therapy

• When the patient is able to eat, transition to a multiple-dose schedule using a combination of short/rapid-acting and intermediate/long-acting insulin 1
• A structured discharge plan tailored to the individual patient may reduce length of hospital stay and readmission rates 1