Intravenous Insulin Regime

A fixed rate intravenous insulin infusion calculated on 0.1 units/per kilogram body weight is recommended.

The insulin infusion is made up of 50 units of soluble human insulin in 49.5 ml 0.9% sodium chloride solution (i.e. 1 unit /ml).

Recommendation (JBDS)

Once the glucose drops to less than 14 mmol/L then in addition to adding a 10% dextrose infusion consider reducing the rate of intravenous insulin infusion to 0.05 units/kg/hr to avoid the risk of developing hypoglycaemia and hypokalaemia.

Metabolic treatment targets

The recommended targets are

• Reduction of the blood ketone concentration by 0.5 mmol/L/hour
• Increase the venous bicarbonate by 3.0 mmol/L/hour
• Reduce capillary blood glucose by 3.0 mmol/L/hour
• Maintain potassium between 4.0 and 5.5 mmol/L

If these targets are not achieved, then the fixed rate insulin should be increased by 1 unit/hr increments hourly until targets achieved

In addition to this if the patients normally use exogenous basal insulin (i.e. Lantus) this should also be administered as normal.