Perioperative insulin management

IV insulin

• Monitor CBG q1h
• IV insulin
  • Mix 25u Humulin R in 250 mL D5W
  • D5W IV 50mL/h while on insulin IV
  • if CBG > 7 x2h, notify Endo

Gestational diabetes nomogram

CBG	Insulin Dose	Infusion Rate
Less than 3.8	0 and follow	0 and follow
	hypoglycemia protocol	hypoglycemia protocol
3.8-6.9	0	0
7-8.9	0.5	5
9-10.9	0.7	7
11 or greater	1 and notify Endo	10 and notify Endo

Low dose nomogram (less than 40 u/d)

CBG	Insulin Dose	Infusion Rate
Less than 3.8	0 and follow	0 and follow
	hypoglycemia protocol	hypoglycemia protocol
3.8-6.9	0.5	5
7-8.9	1	10
9-10.9	1.5	15
11 or greater	2 and notify Endo	20 and notify Endo

Medium dose nomogram (40-59 u/d)

CBG	Insulin Dose	Infusion Rate
Less than 3.8	0 and follow	0 and follow
	hypoglycemia protocol	hypoglycemia protocol
3.8-6.9	1	10
7.0-8.9	1.5	15
9-10.9	2	20
11 or greater	2.5 and notify Endo	25 and notify Endo

High dose nomogram (greater than or equal to 60 u/d)

CBG	Insulin Dose	Infusion Rate
Less than 3.8	0 and follow	0 and follow
	hypoglycemia protocol	hypoglycemia protocol
3.8-6.9	1.5	15
7-8.9	2	20
9-10.9	2.5	25
11 or greater	3 and notify Endo	30 and notify Endo

Hypoglycemia orders

• CBG 2.2-3.7
  • Suspend insulin
  • 175mL juice or add 25mL D50W to a 50mL D5W bag and give immediately (total volume 75mL)
  • Check CBG in 15 minutes, notify Endo if still low
  • When CBG ≥3.8, restart nomogram
• CBG < 2.2
  • Suspend insulin
  • Give 175mL juice or add 50mL D50W to a 50mL D5W bag and give immediately (total volume 100mL)
  • Notify Endo
  • When CBG ≥3.8, restart nomogram

Post-procedure

• Continue IV insulin
• Once eating, start SC insulin
• Stop IV insulin and D5W 1h after first dose of SC short-acting insulin OR 4h after first dose of SC long-acting