How to initiate an intravenous insulin (IV insulin) drip?

From the Guidelines

To start an insulin drip, begin by calculating the initial rate based on the patient's weight, typically 0.1 unit/kg/hour, as recommended by the most recent guidelines 1. When initiating an insulin drip, it is crucial to follow a standardized protocol to ensure patient safety and effective glucose management. The process involves several key steps:

• Gather necessary supplies, including regular insulin, IV solution (usually 0.9% sodium chloride), an infusion pump, and blood glucose monitoring equipment.
• Prepare the insulin solution by adding 100 units of regular insulin to 100 mL of 0.9% sodium chloride, creating a concentration of 1 unit/mL, although the specific concentration may vary based on institutional protocols.
• Prime the tubing to ensure insulin reaches the patient immediately upon starting the infusion.
• Connect the IV to the patient through a dedicated line or port to prevent interference with other medications.
• Begin the infusion at the calculated rate and monitor blood glucose levels frequently, typically every hour initially, then adjusting to every 2-4 hours once stable, as suggested by recent guidelines 1.
• Adjust the infusion rate according to your facility's protocol based on blood glucose readings, keeping in mind the importance of avoiding hypoglycemia and achieving specific glycemic goals, especially in critical care settings 1. Regular monitoring is essential as insulin requirements can change rapidly due to various factors including stress, medications, and nutritional status. Always have dextrose solution available to treat hypoglycemia, and document all glucose readings, insulin rates, and any rate adjustments made during the infusion. The use of validated written or computerized protocols for adjusting the insulin infusion rate based on glycemic fluctuations is also recommended 1.

From the FDA Drug Label

The intravenous administration of Humulin R U-100 was tested in 21 patients with type 1 diabetes The patients' usual doses of insulin were temporarily held, and blood glucose concentrations were maintained at a range of 200 – 260 mg/dL for one to three hours during a run-in phase of intravenous Humulin R U-100 followed by a 6-hour assessment phase. During the assessment phase patients received intravenous Humulin R at an initial dose of 0. 5 U/h, adjusted to maintain blood glucose concentrations near normoglycemia (100 to 160 mg/dL).

To start an insulin drip, the initial dose of intravenous Humulin R U-100 is 0.5 U/h, adjusted to maintain blood glucose concentrations near normoglycemia (100 to 160 mg/dL) 2.

• The dose may need to be adjusted based on the patient's response and blood glucose levels.
• It is essential to closely monitor the patient's blood glucose levels during the infusion.

From the Research

Initiating an Insulin Drip

To start an insulin drip, several factors must be considered, including the patient's condition, the type of insulin, and the dosage.

• The initial dose of insulin can vary depending on the patient's needs and the specific protocol being followed.
• For hyperkalemia management, insulin is often administered with glucose to help lower potassium levels in the blood 3.
• The dose of insulin for hyperkalemia treatment may be adjusted based on the patient's response and the risk of hypoglycemia, with some studies suggesting the use of lower doses, such as 5 units or 0.1 units/kg, to minimize this risk 3.

Considerations for Insulin Drip Management

When managing an insulin drip, it is essential to monitor the patient's blood glucose and potassium levels closely to avoid complications such as hypoglycemia or hypokalemia.

• Patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4-6 hours after administration 3.
• The insulin drip may need to be adjusted based on the patient's response, and other treatments, such as potassium supplements or other medications, may be necessary to manage the patient's condition.
• In patients with diabetes, basal insulin is usually initiated at a conservative dose of 10 units/day or 0.1-0.2 units/kg/day, and then titrated based on the patient's self-measured fasting plasma glucose levels 4.

Special Considerations

In certain situations, such as in patients with combined aldosterone and insulin deficiency, glucose administration can lead to hyperkalemia, and insulin therapy may be necessary to manage this condition 5.

• In patients on long-term dialysis, insulin alone may be sufficient to correct hyperkalemia associated with hyperglycemia 6.
• The management of diabetic emergencies, including hyperkalemia, hypoglycemia, and diabetic ketoacidosis, requires prompt recognition and treatment to prevent serious complications and improve patient outcomes 7.