From the Guidelines
Discontinuing an Intravenous Insulin Infusion Protocol
The protocol for discontinuing an intravenous (IV) insulin infusion involves administering subcutaneous insulin 1 to 2 hours before discontinuing the IV insulin, with the goal of minimizing rebound hyperglycemia while the subcutaneous insulin takes effect 1.
Key Steps in the Protocol
- Subcutaneous Insulin Administration: Subcutaneous basal insulin should be given 1 to 2 hours before intravenous infusion is discontinued, with the aim of minimizing rebound hyperglycemia while the subcutaneous insulin action rises 1.
- Dose Calculation: The dose of basal insulin is best calculated on the basis of the insulin infusion rate during the last 6 hours when stable glycemic goals were achieved 1.
- Converting to Basal Insulin: Converting to basal insulin at 60% to 80% of the daily infusion dose has been shown to be effective 1.
- Monitoring Blood Glucose Levels: Blood glucose levels should be closely monitored during this transition period, with target glucose ranges of 140-180 mg/dL.
Important Considerations
- Preventing Hypoglycemia: Many episodes of hypoglycemia among inpatients are preventable, and a hypoglycemia prevention and management protocol should be adopted and implemented by each hospital or hospital system 1.
- Correct Dosing: For patients transitioning to regimens with concentrated insulin (U-200, U-300, or U-500) in the inpatient setting, it is essential to ensure correct dosing by utilizing an individual pen and cartridge for each patient and by meticulous supervision of the dose administered 1.
Transitioning to Subcutaneous Insulin
The transition protocol is associated with less morbidity and lower costs of care and is therefore recommended 1. A patient with type 1 or type 2 diabetes being transitioned to a subcutaneous regimen should receive a dose of subcutaneous basal insulin 1 to 2 hours before the intravenous infusion is discontinued.
From the Research
Discontinuing an Intravenous (IV) Insulin Infusion
There are no research papers to assist in answering this question, as the provided study 2 focuses on the initiation, titration, and switching of basal insulins in patients with type 2 diabetes, rather than the protocol for discontinuing an IV insulin infusion.
- The study 2 discusses the management of basal insulins, including initiation, titration, and switching, but does not address IV insulin infusions.
- The provided evidence does not include information on discontinuing IV insulin infusions, and therefore cannot be used to inform this process.