Insulin infusion
- 50 ml syringe.
- Dilute 50 units actrapid to total of 50 mls normal saline (giving 1 unit / ml)
- Dilute in saline (for hyperglycaemia) or 5% dextrose (for hyperkalaemia)
- Start infusion depending on hourly BM readings
| Capillary blood glucose (Mmol/L) | Insulin (units/hr) |
|---|---|
| 28 | 10 |
| 17 - 28 | 8 |
| 9 - 17 | 4 |
| 6.5 - 9 | 2 |
| 4.5 - 6.5 | 1 |
| <4.5 | Hold infusion |
- Check level at 22:00 hours. If BM stable at 6 - 7 mmol, halve infusion rate overnight and check BMs hourly.
- Capillary blood glucose must be checked hourly intraoperatively or if glycaemic control is poor, but may be extended to two-hourly if glycaemic control is stable.
- Intravenous fluids should be administered through a separate cannula.
- Dextrose saline should be used if capillary blood glucose is less than 12 mmol per L-1, and normal saline should be used at higher glucose levels. The rate of fluid administration will be governed by the patient’s fluid requirements, state of hydration, etc.
- Subcutaneous insulin can be recommenced when the patient is eating and drinking as normal.
N.B. This sliding scale is arbitrary, and, as insulin requirements vary from person to person, it may be necessary to increase or decrease the amount of insulin used, having established that glycaemic control is sub-optimal with standard sliding scale insulin.
