1 - How can i download the chart?
You can download the chart from this link
2 - Which chart to follow 1 or 2?
Initial loading dose and start of infusion by using chart 1. Infusion protocol is by chart 2.
3 - If GRBS falls by high level ex > 250 to 140- 180 mg/dl how much insulin infusion to reduce?
4 - Can we use the same protocol for DKA/HHS?
No, should follow as advised by doctors
5 - How frequently should we do GRBS on a patient on insulin infusion?
Hourly
6 - GRBS was 110 mg/dl and now its 170 mg/dl, how much infusion to change?
Our target to maintain GRBS is between 140-180 mg/dl, so there is no need to change the insulin infusion
7 - If GRBS increases by high level ex 140- 180to >250 mg/dl how much insulin infusion to increase?
Increase the infusion by 2 rows similar to that of question 3.
8 - When to change to subcutaneous insulin?
• When GRBS is in target range for more than 4 hours
• Patient is hemodynamically stable
• Patient is tolerating feeds either NG or oral
9 - How to change over to subcutaneous insulin?
• Calculate the total requirement of IV insulin last 24 hours
• 80% of the total IV insulin is the SC insulin dose requirement
• 40% of the SC insulin dose is long acting insulin
• 60% is the short acting insulin which should be divided into 3 doses (20% each) before BF, lunch and dinner or 8AM, 2PM and 8PM feeds
• Stop insulin infusion after 2 hours of subcutaneous dose
Example: total IV requirement 50U, SC insulin requirement 40 U, long acting insulin 16 U, short acting insulin 24 U divided by 3 doses, 8U each.
