How is an IV insulin therapy protocol selected?

Updated: Nov 06, 2018
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: George T Griffing, MD  more...
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The success of an insulin protocol depends on many different variables. Various protocols have been developed and modified by different institutions, with the choice often based on elements that are especially suited to the institution. A specific protocol cannot be endorsed as implementation and the success of the protocol will depend on several factors including patient population, ease of use, expertise and experience of staff, infrastructure and medical resources. Each protocol has a learning curve, especially if staff members are not accustomed to the use of intravenous insulin infusions for glucose control. The protocols are labor intensive and require extra nursing time for implementation. Hourly glucose determinations are required initially; if only 5 minutes are devoted to each check, 12 adjustments to the infusion in a day translates into an extra hour of nursing time. Although experience with insulin infusions used to treat diabetic ketoacidosis will help the transition to these intravenousinsulin protocols, the need for close oversight cannot be overestimated. It is acknowledged that the need for bedside calculation of insulin dose adds to the potential for errors in dosing, especially when paper based protocols are used. Preprinted dosing charts and computerized protocols that eliminate the need for calcuation are available and may minimize this problem.

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