From the Guidelines
When preparing intravenous insulin in normal saline, add 100 units of regular insulin to 100 mL of 0.9% sodium chloride (NS), creating a concentration of 1 unit/mL, as recommended by the most recent guidelines 1. To ensure accurate delivery, it is crucial to prime the IV tubing with a 20-mL waste volume of the insulin solution before administration, as suggested by earlier guidelines 1.
Key Considerations for Administration
- Use an infusion pump for precise delivery and monitor blood glucose levels frequently, typically hourly until stable, then every 2-4 hours.
- The insulin infusion rate should be adjusted based on blood glucose readings and institutional protocols, commonly starting at 0.1 units/kg/hour, as indicated in recent standards of care 1.
- Regular insulin is preferred for IV administration due to its rapid onset of action and short duration.
- Always follow your institution's specific protocol for insulin infusions, as practices may vary.
- Proper labeling of the solution is essential, including patient name, concentration, date, time of preparation, and expiration time (typically 24 hours after preparation).
Clinical Context and Adjustments
- The target glucose range for critically ill patients is between 140–180 mg/dL (7.8–10.0 mmol/L), with potential for lower targets in select patients, as discussed in earlier guidelines 1.
- Adjustments to the insulin infusion rate should be made based on blood glucose readings, aiming to maintain the patient within the target glucose range while minimizing the risk of hypoglycemia.
From the FDA Drug Label
For intravenous use, Humulin R U-100 should be used at concentrations from 0.1 unit/mL to 1 unit/mL in infusion systems with the infusion fluids 0.9% sodium chloride using polyvinyl chloride infusion bags.
The guidelines for IV insulin in NS pint are to use concentrations from 0.1 unit/mL to 1 unit/mL in infusion systems with 0.9% sodium chloride using polyvinyl chloride infusion bags 2.
From the Research
IV Insulin in NS Pint Guidelines
- The use of intravenous insulin infusion for managing inpatient hyperglycemia is a common practice, and guidelines have been developed to provide practical guidance on its use 3.
- When administering IV insulin, it is essential to consider variables such as ambient blood glucose level and magnitude of blood glucose change in the previous hour to adjust the infusion rate accordingly 3.
- In cases of hypoglycemia, intravenous dextrose is often used as a treatment, and the dose of dextrose can impact the development of hypoglycemia, with 50g of dextrose potentially being beneficial in select patient populations 4.
- For the management of hypoglycemia, both 10% dextrose (D10) and 50% dextrose (D50) are effective options, with similar hospital mortality rates 5.
- In the treatment of diabetic ketoacidosis (DKA), low-dose insulin is non-inferior to standard-dose insulin, and subcutaneous insulin can be associated with reduced ICU admissions and hospital readmissions in children 5.