Insulin

Question 1

Indications - Insulin

Answer 1

❑ Diabetic ketoacidosis
❑ Hyperkalemia
❑ Hyperglycemia
❑ Beta-blocker / Calcium blocker toxicity: Administration of high-dose insulin in patients with shock refractory to other measures may be considered. IV insulin, accompanied by IV dextrose supplementation and electrolyte monitoring, may improve hemodynamic stability and survival in beta-blocker overdose by improving myocardial energy utilization.

Question 2

Dosage for Insulin in Hyperglycemia / DKA

Answer 2

Adult/Pediatric - 0.1 u/kg/hr IV infusion; it is important to reduce the serum glucose concentration gradually. Aim for a gradual reduction at a rate of 2.8 to 4.2 mmol/L per hour. If serum glucose does not decrease by at least 10% from the initial value in the first hour, the dose of insulin should be increased until a steady glucose decline is achieved. When serum glucose reaches 11.1 mmol/L, the insulin infusion rate may be decreased to 0.02 - 0.05 u/kg/hr, and dextrose added to the IV solutions to help prevent hypoglycemia from occurring.

Question 3

Dosage of Insulin for Beta-blocker / Calcium blocker toxicity

Answer 3

1 u/kg regular insulin as a bolus, followed by continuous infusions of 1 U/kg per hour of insulin; dextrose should be added to IV fluids. The insulin infusion is titrated as needed to achieve adequate hemodynamic response, whereas the dextrose infusion is titrated to maintain serum glucose concentrations of 5.5 to 14 mmol/L. *For Infusions Mix: 100 u in 100 ml of NS [1 unit/ml]

Question 4

Dosage of Insulin for Hyperkalemia

Answer 4

Adult/Pediatric - 10 U regular insulin given over 10 – 15 min IV; followed with 25g of D50W over 15 – 30 min IV (shifts potassium into the cell).

Question 5

Contraindications - Insulin

Answer 5

None when used for the indications in this card set.