Insulin Orders & Protocols: IV Insulin Infusions

Examples of Intravenous Insulin Infusion Order Forms and Transition to Subcutaneous Regimens

Examples of Intravenous Insulin Infusion Protocols

Atlanta Medical Center Protocol
Osburne RC, Cook CB, Stockton L, et al. Diabetes Educ. 2006;32:394-403.
View the Atlanta Medical Center Protocol

North Carolina Protocol
Braithwaite SS, Edkins R, MacGregor KL, et al. Diabetes Technol Ther. 2006;8:476-488.
View the North Carolina Protocol

Yale Insulin Drip Protocols
Submitted by Silvio Inzucchi.
View Yale “New” Insulin Drip Protocol (target 90-119)
View Yale Insulin Drip Protocol (target 100-139)

Protocols Integrated into Order Sets

Northwestern University Inpatient Intravenous Insulin Protocol
DeSantis AJ, Schmeltz LR, Schmidt K, et al. Endocr Pract. 2006;12:491-505.
Recently published, the Northwestern protocol uses three tables to adjust rates. Goal of 80-110 mg/dL is reached in 10.6 hours. Hypoglycemia < 60 mg/dL is reported to be 1.6%.
View the Northwestern University Inpatient Intravenous Insulin Protocol

Banner Good Samaritan Medical Center CABG IV Insulin Protocol (unpublished)
Submitted by Dr. Cheryl O'Malley; shows transition to subcutaneous insulin built into IV infusion order set.
View the Banner Good Samaritan Medical Center CABG IV Insulin Protocol

Critical Care Adult Insulin Infusion
Southwestern Washington Medical Center, submitted by Chris Hogness.
View Critical Care Adult Insulin Infusion

Transition to Subcutaneous Regimens

Important steps in transitioning from insulin infusion to subcutaneous insulin
This table was published in The Journal of Hospital Medicine as part of the SHM Glycemic Control Task Force Supplement, Improving Care of the Hospitalized Patient with Hyperglycemia and Diabetes. View the supplement chapter: Bridge Over Troubled Waters: Safe and Effective Transitions of the Inpatient with Hyperglycemia for context and more information.
View the table outlining Important steps in transitioning from insulin infusion to subcutaneous insulin

Critical Care Insulin Transition Protocol: Intravenous to Subcutaneous
Submitted by Cheryl O’Malley Good Samaritan Regional Medical Center, Phoenix
View the Critical Care Insulin Transition Protocol: Intravenous to Subcutaneous

Northwestern University Transition from IV to SC Insulin Protocol
DeSantis AJ, Schmeltz LR, Schmidt K, et al. Endocr Pract. 2006;12:491-505.
View the Northwestern University Transition from IV to SC Insulin Protocol

IV Guidelines from Loyola completing subq set
Guideline for Intravenous Insulin Infusion in the Adult ICU Patient
Loyola University Health System. Submitted by Maryann Emanuele
View the Guideline for Intravenous Insulin Infusion in the Adult ICU Patient

Transition from IV to SQ Insulin in the Adult Patient
Loyola University Health System. Submitted by Maryann Emanuele.
View the Transition from IV to SQ Insulin in the Adult Patient

University of California, San Diego Transition from IV to SQ Insulin Protocol
This protocol for transitioning from infusion insulin has now been validated as being safe and effective (abstract / publication pending). Glycemic control was improved from a standard practice control group, while hypoglycemic events were even less common in the transition protocol group than in the standard practice group. The effort was funded by an ASHP (American Society of Healthsystems Pharmacists) grant to foster and role model collaboration between pharmacists and hospitalists. The protocol is now being used in all critical care wards at UCSD.
View the UCSD Transition from IV to SQ Insulin Protocol

Other Resources