IV insulin Flashcards
When would IV insulin be given to a patient with diabetes ?
If they are:
- Acutely unwell
- Have DKA
- Hyperosmolar hyperglycaemic state (HHS)
- Fasting/ patients who are unable to tolerate oral intake
- Some antenatal (pregnant) patients who are receiving high dose steroids for potential pre term labour
Due to insulin having a very short half life (approx 5mins) if the infusion is inadvertently disconnected what is their a risk of ?
Risk of insulin omission which can lead to DKA
What does the prolonged use of IV insulin increase the risk of?
Increases risk of IV cannula-related complications such as infection and electrolyte abnormalities (e.g. hyponatraemia - occurs due to low sodium levels)
What does IV insulin infusion management involve?
It involves separate infusions of IV fluid (glucose and potassium) and insulin
How is IV insulin prescribed?
Prescribed on the main drug kardex, highlighting continual infusion over 24hrs then out the variable rates on the IV insulin prescription chart
How is IV insulin given?
Using an insulin syringe 50units of soluble insulin (e.g.actapid) in 49.5ml 0.9% sodium cholride (1 unit per ml)
The insulin is then infused via a syringe driven pump
In order to reduce the risk of DKA what should all patients who are usually prescribed multiple daily injections continue?
Should continue the prescription for long acting basal insulin S/C injection e.g. Glargine(Lantus), Determir (levemir)
This promotes safe trasfer from IV insulin to S/C insulin
How many different insulin scales are there on the insulin prescription chart?
4 these represent different insulin units per hour regimes
What is scale 1 on the insulin prescription chart for giving patients IV insulin ?
It is the standard insulin scale which is initially commenced
What is scale 2 and when is it used?
Used if scale 1 fails to control glucose levels and they remain high, (e.g. for insulin resistant patients e.g. obese) this is a higher insulin rate per hour regime than scale 1
What is scale 3 and when is it used?
It is a reduced insulin rate per hour regime (approx half that of scale 1) for insulin sensitive patients
It is used if there is hypoglycaemia on scale 1, or if the total amount of insulin is less than 24units per day, scale 3 should be used
What is scale 4 and when is it used ?
This scale can be created to suit an individuals needs, e.g. a patient prescribed high dose steroids who may have very high dose steroid requirements. So the rate given each hour is not a set regime it can be catered to the patient s
Delivery of IV fluids and insulin should be through the same cannula (or 2 lumens of a central line) - T/F?
True
Who must check infusion settings and when must this be done ?
2 practitioners and must be done at commencement and when there is any change in settings
How often must infusion solutions be discarded ?
after 24hrs
