What are indications for cessation of the Portland IV insulin therapy protocol?

Updated: Nov 06, 2018
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: George T Griffing, MD  more...
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Answer

Answer

Protocol cessation permissible only on transfer is indicated in the following:

  • Diabetic patients more than 3 days since last operation or ICU admission and eating more than 50% of a regular diet.

    • If admission HgbA1c is less than 6.5%: Restart preadmission glycemic control meds at 7 am on day of transfer and stop intravenous insulin infusion at 9 am prior to transfer

    • If admission HgbA1c is more than 6.5%: Consider additional basal-prandial subcutaneous insulin therapy. Initiate Portland Basal-Prandial SQ Insulin Transition Protocol©.

  • Continue to monitor blood glucose before meals, 2 hours after meals, and at bedtime throughout rest of hospital stay.

  • Nondiabetic euglycemic patients may stop the protocol if they meet criteria outlined above.

  • Nondiabetic patients who remain hyperglycemic beyond the postoperative day 3 have no need to continue protocol upon transfer. However, endocrinology consultation should be requested by a physician.


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