Prince Faisal bin Khalid Cardiac Center

Abha, Saudi Arabia

Nursing Education
Department

INSULIN
PROTOCOLS

DISCLAIMER: PROTOCOL are minimum standards but are not

DEFINITE. The treatment regimen will be dictated by the patient’s
clinical responses to INSULIN.
Objective

 At the end of the presentation, RNs will be

able to:
1. Determine the indications for initiating a
specified Insulin protocol.
2. Be familiar with the procedure of titrating IV
insulin infusion.
OVERVIEW OF Diabetes Mellitus
 TWO TYPES:

1. Insulin Dependent

2. Non-insulin Dependent
3. Gestational

 Cardinal Signs:

1. Polydipsia

2. Polyuria
3. Polyphagia

 Diagnostic Test

HbA1C (>6%)
WHY DO WE NEED INSULIN?

 Glucose Control
 Fat storage
What Causes HYPERGLYCEMIA?
 Body not producing enough INSULIN
 Intake of carbohydrates is not balanced with the amount of
insulin in the body
 Inactivity (e.g. sedentary lifestyle)
 Stress (physical, emotional)
 Steroid drugs
PFKCC PROTOCOL ON INSULIN
ADMINISTRATION
 INSULIN PROTOCOL FOR NON-
CRITICALLY ILL DIABETIC PATIENT
 Measure HBA1c (>6%)
 Target Blood Glucose is 140-180 mg/dl

• Not taking any OHA: Start HOME DOSE or 0.2-0.3 units/kg/day. For consistently
ADD CORRECTION (following SLIDING SCALE) SC Insulin if BG is uncontrolled
>151 mg/dl FOLLOWING Q6 SLIDING SCALE.
• Taking OHA: Stop OHA, start CORRECTION SC Insulin (following BG:
TOTALLY NO SLIDING SCALE) if BG is >151 mg/dl FOLLOWING Q6 SLIDING
NUTRITIONAL SCALE. • Adjust basal
INTAKE insulin 10-
20% every
1-2 days.
• Adjust
correction
• If BG is controlled: Continue HOME DOSE. by 1-2 units
• If BG is poorly controlled: start 0.2-0.3 units/kg/day INSULIN SC, every 1-2
Add INTERMEDIATE acting NPH q12 OR LONG ACTING glargine days.
q24. If BG is still uncontrolled, add CORRECTION DOSES

EATING (following SLIDING SCALE Q6) 1-4units/50 mg increments.

 INSULIN PROTOCOL FOR NON-CRITICALLY
ILL DIABETIC PATIENT
CORRECTION DOSES

All Type 1 DM should be on basal insulin.

All OHA should be discontinued preop and pre-contrast.
 INSULIN PROTOCOL FOR NON-CRITICALLY
ILL DIABETIC PATIENT
 Indication for REFERRAL to a physician:
1. Uncontrolled Hyperglycemia
2. Type 1 DM
3. Hypoglycemia with RBS <70 mg/dl or with symptoms
4. Suspicion of DKA:
 RBS >250 MG/DL
 Ph >7.3
 HCO3 > 18
 Ketonuria
 Abdominal pain
 vomiting
 CONTINUOUS IV INSULIN INFUSION
PROTOCOL
 Applicable to all diabetic patient in need of an IV insulin
infusion.
 Applicable to patients w/o history of DM but BG is ≥180
mg/dl.
 Monitor BG hourly.
 Target BG is 140-180 mg/dl.
 Insulin should only be diluted with NSS (0.9% NaCl IV fluid) in
a 1:1 concentration.
 Intraoperative NON-DIABETIC: Start when BG is consistently
>180mg/dl.
 Intraoperative DIABETIC: Start at the beginning of the
procedure to maintain BG at 140-180 mg/dl.
Continuous IV Insulin Infusion Protocol
PRACTICE TEST
1. The patient is on continuous IV Insulin Infusion. In the last
hour, BG was 250 mg/dl. Current check shows a blood glucose
of 240 mg/dl. If the current infusion rate was 4 unit/hour, what
will the RN do?
A. Keep the same rate
B. Decrease the rate by 2 units/hour
C. Increase the rate by 2 units/hour

2. After one hour, the BG further decrease to 225 mg/dl. How

will the RN set the infusion rate?
A. Set at 6 units/ hour
B. Set at 8 units/hour
C. Do not change the infusion rate
PRACTICE TEST
3. In the next hour of checking BG, the finding was 130 mg/dl.
What is the next nursing action?
A. Decrease the rate by half of the previous rate
B. Do not change the rate
C. Hold the infusion

2. The following hour, the BG again spike up to 182 mg/dl.

What will the nurse do?
A. Resume Insulin infusion at 4 units/ hour.
B. Keep the infusion on hold.
C. Resume infusion at 0.5 units/ hour
 References
1. https://www.diabetes.co.uk/body/insulin.html
 Questions and Suggestions
will be reviewed by the
NURSE EDUCATION TEAM
through your participation in our
SURVEY MONKEY Feedback Questionnaire.
Link will be sent through your Whatsapp.
Jazakallahu Khair!!!