What are the Portland Protocol Titration Guidelines for IV insulin therapy if the blood glucose level is >300 mg/dL?

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

Answer

Blood glucose level >300 mg/dL

  • If lower than the last blood glucose level by more than 150 mg/dL, decrease the rate by half (50%)

  • If lower than the last blood glucose level by 101-150 mg/dl, keep the same rate.

  • If lower than the last blood glucose level by 0-100 mg/dL or higher than the last blood glucose level, with 10 Units of regular insulin intravenously and double the insulin rate up to a maximum of 30 U/h.

  • If the blood glucose level remains greater than 300 mg/dL and has not decreased after 3 consecutive increases in insulin administer double the previous intravenous bolus dose up to a maximum of 40 U and double the insulin drip rate up to a maximum of 30 U/h.

  • If on 30 units/hour and no response after 4 maximum boluses, call physician for further orders.

o Recheck the blood glucose level in 30 minutes. Repeat blood glucose monitoring every 30 minutes until it is less than 200 mg/dL.

o If the level is more than 300 mg/dL for more than 4 consecutive readings, call the physician for additional intravenous bolus orders.


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