Description and indication for use
Insulin is a protein hormone formed by the
beta cells of the Islets of Langerhans of the pancreas and secreted into the
blood, where it regulates carbohydrate, lipid and amino acid metabolism.
Insulin is used to maintain normoglycaemia
in infants with persistent glucose intolerance and as adjuvant therapy in the
treatment of hyperkalaemia in critically ill infants.
Dose
Hyperglycaemia
SC:
0.05 to 0.2 units/kg – 4 to 6 hourly.
IV Infusion:
0.01 to 0.1 units/kg/hour. Monitor blood glucose at least every 30
minutes initially.
Titrate infusion according to blood glucose
results.
Hyperkalaemia
IV:
0.1 units/kg with 2 mL/kg of Glucose 50%.
Reconstitution/Dilution
Vial = 100 units/mL (Refrigerate).
SC:
Dilute to 1 unit/mL with saline, as
described: withdraw Insulin 100
units/mL solution and add to sodium chloride 0.9% in a second syringe as shown
in the table below:
|
Volume
Of Insulin 100 units/mL
|
Volume
of Sodium chloride 0.9%
|
Final
Volume
|
Final
Concentration**
|
|
0.1 mL
|
0.9 mL
|
1 mL
|
10 units/mL
|
|
0.1 mL
|
1.9 mL
|
2 mL
|
5 units/mL
|
|
0.1 mL
|
9.9 mL
|
10 mL
|
1 unit/mL
|
**The dilution that enables measurement of the dose with minimum volume
should be used.
NB. For withdrawing and giving
actual dose please refer to Method of Administration (over the page).
IV infusion:
Withdraw required dose and make up to
ordered volume of infusion fluid.
Add 5 units/kg Insulin to 50 mL of infusion
solution and infuse at 1 mL/hr to give 0.1 units/kg/hour.
If amount to be added to the infusion
solution is not measurable at 100 units/mL, a dilution can be made as follows:
Withdraw 0.1 mL
of 100 units/mL solution and add to 0.9 mL of sodium chloride 0.9% in a second
1 mL syringe = 10 units/mL
|
Drug
|
How
to make up
|
Dose
equivalent
|
Dose
range
|
|
Insulin
|
5 units/kg in 50 mL
|
1 mL/hr = 0.1 units/kg/hr
|
0.02 to 0.1 units/kg/hr
|
Infusion solution
should be changed every 24 hours.
Draw up 0.9mL of
Albumin 20% and add to 49.1mL of infusion solution (this will minimise the loss
of insulin through adherence to syringe and line).
For hyperglycaemia use Sodium chloride 0.9%, or Glucose 5% as the
infusion solution.
Route and method of administration
SC:
Use Insulin syringe to withdraw dose and
give SC injection.
IV infusion:
Give at ordered rate via syringe pump.
Side effects
Hypoglycaemia (sweating, tachycardia), hyperinsulinism,
hypokalaemia.
Compatible Solutions
Fluids:
Sodium Chloride 0.9%, Glucose 10%, Glucose
5%, TPN, Intralipid.
Drugs:
Ranitidine.
Via Y-site:
Dobutamine, Gentamicin, Heparin, Imipenem, Magnesium Sulphate, Morphine,
Potassium Chloride, Ticarcillin-Clavulanate, Tobramycin, Vancomycin.
When giving an infusion for hyperglycaemia,
it is best to give the insulin in Sodium Chloride 0.9% or Sodium Chloride 0.45%.
Incompatibilities
Fluids:
No information.
Drugs:
Aminophylline, Bbenzylpenicillin, Digoxin, Dobutamine,
Sodium Bicarbonate, Phenytoin.
Insulin is incompatible with many drugs.
Other
drugs or solutions must not be bolused via the insulin line.
Administer alone or contact pharmacy for
further information.
Drug interactions
|
Propranolol
|
May increase the effect of Insulin.
|
|
Corticosteroids, Chlorothiazide, Adrenaline, Glucagon,
Phenytoin
|
May decrease the effect of Insulin.
|
Nursing responsibilities
Monitor heart and respiratory rate.
Monitor blood glucose at least every 30
minutes following commencement of infusion, then 2 to 4 hourly initially, then
as necessary.
Test urine for glucose once per shift.
Strictly avoid giving boluses of Insulin,
infuse alone.
Monitor blood glucose 1 hour after any
increase in infusion rate.
Check that infusion rate corresponds to
required dose (units/kg/hr).