IV Insulin Treatment

Question 1

what are the indications of IV treatment in patients with diabetes

Answer 1

acute illness, DKA, Hyperosmolar hyperglycaemic state(HHS), patients fasting or unable to take orally, some antenatal taking on high dose steroids

Question 2

what patients is IV insulin generally not suitable for

Answer 2

in well patients who are eating and drinking

Question 3

describe how there can be a risk of insulin omission

Answer 3

IV insulin has very short half life of 5mins, so if infusion is inadvertently disconnected risk of omission

Question 4

what complication can arise from insulin omission

Answer 4

diabetic ketoacidosis

Question 5

what type of chart is insulin prescribed on

Answer 5

the main drug kardex

Question 6

what information is written on the main drug kardex when prescribing insulin

Answer 6

highlights continual infusion over 24 hours

Question 7

what information is written on an IV insulin prescription chart

Answer 7

variable rate of insulin

Question 8

describe how to prepare an IV insulin solution if there isn’t a pre-filled syringe available

Answer 8

use an insulin syringe to add 50 units of soluble insulin in 495ml 0.9% sodium chloride

Question 9

describe what adjustable variable rate insulin infusion is

Answer 9

insulin doses administered based on blood glucose levels, standard scale doesn’t fit all

Question 10

how is the risk of developing DKA reduced in patients, who usually prescribed multiple daily injection regimes, now receiving IV insulin treatment

Answer 10

should continue there prescription for long acting basal insulin subcutaneous injection while receiving IV insulin

Question 11

when is scale 1 used in variable rate insulin infusion, also known as a sliding scale

Answer 11

standard insulin scale initially commenced

Question 12

describe when is scale 2 used in variable rate insulin infusion, also known as a sliding scale

Answer 12

if scale 1 fails to control glucose level and is still too high, amount of insulin should be increased and scale 2 used
(eg if patient insulin resistant)

Question 13

describe when is scale 3 used in variable rate insulin infusion, also known as sliding scale

Answer 13

if there is hypoglycaemia on scale 1, or if total daily amount of insulin is less than 24 units a day
scale 3 = reduced amount of insulin
(eg if patient insulin sensitive)

Question 14

describe when is scale 4 used in variable rate insulin infusion, also called sliding scale

Answer 14

scale 4 can be used to create a scale for individual needs

Question 15

what 2 valves should be used to ensure both IV fluid and insulin remain infusing safely

Answer 15

anti-syphon valve and anti-reflux valve

Question 16

when might meal time insulin be given alongside IV insulin, which it isn’t normally

Answer 16

following DKA or in some antenatal patients

Question 17

when transferring from IV to subcutaneous insulin when and what should be given

Answer 17

stop IV insulin 30-60mins after both subcutaneous fast and long acting basal insulin has been given

Question 18

when transferring from IV to subcutaneous insulin when and what should be given for those on fixed mixed insulin

Answer 18

stop IV 30-60 mins after fixed mixed insulin been given

Question 19

how often should blood glucose be checked in the first 24 hours after stopping Iv insulin

Answer 19

minimum of 4 times daily

Question 20

when can a patient be transferred back to oral medication

Answer 20

when clinically stable and eating food/drinking

Question 21

what are the 5 key targets for IV insulin treatment

Answer 21

hourly blood glucose monitoring, target blood glucose 6-12, avoid hypoglycaemia, daily U&Es, safe transfer from IV to oral