Wellington ICU Drug Manual © 2023
This protocol standardises the use of insulin infusions in ICU paients. Patients requiring insulin in ICU do not need a previous diagnosis of diabetes. Hyperglycaemia is commonly observed in critically ill patients as part of a stress response or as a side-effect of medication. It is associated with increased morbidity & mortality irrespective of the reason for admission although intensive glucose control (4.5 - 6 mmol/L) may also increase the risk of death.
The default blood glucose level (BGL) target range for patients in Wellington ICU is 6 - 12 mmoL/L
Patients with type I diabetes always need insulin. Discuss with medical staff before ceasing insulin for > 1 hour.
Always check blood ketones on admission for all patients with T1DM or T2DM on empagliflozin
This protocol is available as a PDF to print for use at the bedside.
Insulin infusions increase the risk of hypoglycaemia. This risk is higher in unconscious or sedated patients who cannot report symptoms. Infusions may also cause hypokalaemia as insulin promotes cellular uptake of potassium. Monitoring of serum potassium via venous or arterial blood gas is sufficent and may require supplementation.
Move UP a scale (from A to B, B to C, C to D etc.) or DOWN a scale (from D to C, C to B, B to A etc.) if the following criteria are met:
Inform medical staff if any patient requires ≥ 8 mLs/hr (8 IU/hr)
Higher hourly infusion rates can be prescribed in blank Scale E if Scale D is insufficient to achieve blood glucose target range.
Type 1 diabetics require insulin all the time. They are at risk of ketosis if insulin is stopped for > 1 hr. They should almost always have long-acting subcutaneous insulin commenced before discharge.
Referrals are electronic through MAP:
Select Patient ⇒ Add New Document ⇒ Diabetes Inpatient Referral