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Cardio Diabetes Medicine 2017 505

livers individualized basal and bolus insulin replace- How to initiate?
ment doses based on blood glucose self-monitoring
results. Advanced insulin pumps also have an “in- Must start basal insulin inj. at least 2 h before dis-
sulin on board” feature that adjusts a high blood continuation of IV insulin infusion to prevent re-
glucose correction dose to correct dose. Device is bound hyperglycemia
about the size of a pager. Usually placed on belt or Which insulin to start with?
in a pocket, and insulin is infused through thin plas- Long-acting peakless basal insulin analogue is pre-
tic tubing that is connected to the subcutaneously ferred
inserted infusion set.
What dose to start with?
CSII delivery is regarded as the most Insulin dose given to the patient during the previ-
physiologic method of insulin replacement ous 6 hours should be extrapolated to a 24-hour
dose, and then reduced by 20 percent as a safety
factor to calculate the new TDD

Converting From IV TO SC insulin
Establish 24 hour requirement-Extrapolate from aver-
age insulin requirement over the last 4-6 hours (BG
should be in target and insulin dose should be sta-
MONITORING OF BLOOD GLUCOSE IN ble).Give one half of insulin amount as basal.
CRITICALLY ILL IN PATIENT Give another half of insulin as total bolus - Give bo-
lus dose (1/3 of the total bolus) post meal based on
proportion of food(carb)consumed,Monitor blood
glucose 3rd hourly,Give correction bolus for all BG
> 140mg/dL .
OUR ICU INSULIN PROTOCOL :
Target Range for Glycemic Control: 80-110 mg/dL
(fasting)
Standard drip 50 units/50 mL 0.9% NaCl .
IV insulin include Regular, aspart
Bolus dose and Initial Infusion rate: Divide initial glu-
cose level by 100, then round to nearest 0.5 units for
bolus AND initial infusion rate
Examples : Initial glucose=326 mg/dL: 326÷100=3.26,
round to 3.5: IV bolus 3.5 units + start infusion @ 3.5
units/hour

Adjusting IV insulin

Blood glucose level IV insulin drip
<100mg/dl No Insulin
100-150mg/dl 3units/hour
150-200mg/dl 5units/hour
IV TO SC INSULIN :SOME PRACTICAL TIPS 200-250mg/dl 7units/hour
Till when should IV insulin be continued? >250mg/dl 10units/hour
• Conversion should be postponed until volume
resuscitation or pressor support can be discon- Monitoring blood glucose every hourly
tinued. IV insulin to S/c Insulin: 80% of total iv infusion in 6
hours given divided 50% into basal and 50% in bolus
• Continue IV insulin until patient is able to tolerate
solid food intake insulin according to the blood sugar.

Cardio Diabetes Medicine