Lightning Learning: Variable Rate Insulin Infusion
STOP!
Indications?
Hyperglycaemia (HG) in patients with known diabetes or hospital-related HG who are unable to eat or drink; are vomiting; who are acutely unwell; or for whom adjustment of their own insulin regimen is not possible.
NOT FOR DKA OR HHS (use other guidelines)
Practical Aspects?
Withhold usual diabetes treatment during the VRII but if the patient is on SC background insulin continue this.
Prescribe insulin infusion.
.Ensure a substrate (dextrose) is prescribed with the VRII to prevent hypoglycaemia.
CBG monitored hourly & review at 6 hours to ensure in target range.
LOOK
What Fluid?
1st choice in Adult ED: 5% glucose with 20 mmol/L KCl at 125 ml/hr if serum K is 3.5-5.5 mmol/L
K+ Supplementation: aim to keep K+ 4.0-5.0 mmol/L
If serum K+ >5.5 no additional K
If serum K+ <3.5 senior review
Check K+ regularly
Rate of Infusion?
No risk of fluid overload 125mls/hr
Risk of fluid overload, frail or elderly use 10% glucose 83mls/hr
Fluids MUST run through a pump.
The Dextrose infusion is NOT for volume replacement, but to help prevent hypoglycaemia.
