IV Based: Yale Insulin Infusion Protocol
For diabetic patients in critical care, labor and delivery, and perioperative inpatient settings, there needs to be a type of insulin therapy that is dependent on at least hourly monitoring of blood glucose levels. Intravenous (IV) infusion is the solution for matching insulin dosage to rapidly changing glucose levels. Currently, hospitals intravenously infuse insulin based on glucose monitoring in accordance with various established protocols. An ideal protocol is one that maintains blood glucose in a safe range and has a clear algorithm for dose titration, which includes not only a patient's current blood glucose, but also the rate of change in the patient's blood glucose. Finally, as over dosage of insulin can cause hypoglycemia (lower than normal blood glucose levels), the ideal protocol should minimize hypoglycemia and provide specific instructions for prompt treatment of hypoglycemia should it occur.
The most prevalent intravenous (IV) insulin infusion protocol is the Yale Insulin Infusion Protocol. It is an FDA approved insulin dosing calculator based on a research by Goldberg et. al in 2004. The protocol involves determining which category of blood glucose ranges that the current blood glucose level belongs, then determining whether there was an increase or decrease in the blood glucose level as compared to the last blood glucose monitoring and by how much. Based on the blood glucose range, and the rate of change, the following change in the insulin infusion rate is recommended:
The most prevalent intravenous (IV) insulin infusion protocol is the Yale Insulin Infusion Protocol. It is an FDA approved insulin dosing calculator based on a research by Goldberg et. al in 2004. The protocol involves determining which category of blood glucose ranges that the current blood glucose level belongs, then determining whether there was an increase or decrease in the blood glucose level as compared to the last blood glucose monitoring and by how much. Based on the blood glucose range, and the rate of change, the following change in the insulin infusion rate is recommended: