[ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats.

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1 Glycemic Control - Insulin Infusion NOTE: For treatment of Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome please go to order set named Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS)" Height Weight Allergies General Notify Provider [ ] Notify provider Routine, Until discontinued, Starting S Pulse greater than: Respiratory rate less than: Respiratory rate greater than: Temperature greater than (celsius): Urine output less than (ml/hr): Systolic BP greater than: Systolic BP less than: Diastolic BP greater than: Diastolic BP less than: Other: Notify provider if BG is greater than 200 mg/dl for CTS patients. For CTS patients - Check 0400 BG POD #1 and POD #2. Notify provider if BG is greater than 200 mg/dl. Transition from Insulin Infusion [ ] Nursing communication Routine, Once For 1 Occurrences, If long acting insulin is ordered, administer 1st dose of long acting insulin and discontinue insulin infusion 2 hours later. [ ] POCT glucose Routine, Once For 1 Occurrences, Transition from insulin infusion - POCT glucose 3 hours after insulin infusion stopped. Give insulin subcutaneous per correction scale. [ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats. Labs [ ] Hemoglobin A1c Once For 1 Occurrences Do not draw if patient received blood transfusion within 3 months. [ ] Basic metabolic panel Once Provider s Initial: Page 1 of 6 Glycemic Control Insulin Infusion

2 Medications Pharmacy Consult Insulin Drip Highline only [ ] Highline Only Pharmacy Consult for Insulin Drip Routine, Once SAH, SCH, SFH, SJMC & Highline Insulin Infusion Discontinue all previous SQ insulin [X] POCT glucose [X] insulin regular 1 unit/ml 100 ml infusion [ ] ( Nutritional Insulin if patient eating) insulin aspart (NovoLOG) injection Routine, Every hour, If result shows HI or LOW place stat serum glucose per written order. Continue hourly then modify order to frequency of every 2 hours once 3 consecutive blood glucose results within goal range (100 mg/dl 180 mg/dl) 1 Units/hr, IntraVENous, Titrated [A] Start insulin infusion when BG is100 mg/dl or greater. (Check BG hourly) [B] Calculate drip rate using the following formula: (BG-60 x multiplier = drip rate), round to the nearest unit. [C] To Calculate Initial Rate: Use multiplier = 0.03 [D] To Titrate Drip: 69 or less: (Hypoglycemia Protocol); 70-99: Decrease multiplier by 0.01; : No change in multiplier; 181 or greater increase multiplier by Maximum infusion rate = 50 units/hour. Contact provider if higher dose required If long acting insulin is ordered, administer 1st dose and discontinue insulin infusion 2 hours later Units, SubCutaneous, 3 times daily with meals **Nutritional Insulin If patient remains on insulin infusion while eating, do not adjust the infusion within 2 hours of giving insulin aspart, but continue to check BG every hour. Insulin aspart needs to be given before the meal or if uncertain that the patient will eat, give after. * If patient eats less than 50% of meal - give 3 units of insulin aspart subcutaneously * If patient eats greater than or equal to 50% of meal - give 6 units of insulin aspart subcutaneously Will this be administered via an insulin pump? Provider s Initial: Harrison Insulin Infusion Page 2 of 6

3 Please Select Harrison Insulin Infusion Goal of this protocol is to decrease glucose by mg/dl per hour Glucose Goal Range: 120 mg/dl to 180 mg/dl Intravenous fluids are to be ordered separately Initiating Insulin Drip: Algorithm 1: For patients who don't meet criteria for Algorithm 2 Algorithm 2: For CABG patients (current or past) or patients receiving glucocorticoids or on parenteral nutrition (TPN or PPN) or patients with diabetes receiving greater than a total daily dose of 80 units of insulin as an outpatient. Move to the algorithm to the right if deemed Algorithm failure. Algorithm failure is defined as blood glucose above 180 mg/dl and the blood glucose has not decreased by at least 60 mg/dl within the past 1 hour. If both criteria are met, begin using the next algorithm to the right. Discontinue all previous SQ insulin BG Less than 70 mg/dl follow Hypoglycemia Protocol Insulin Infusion Algorithm Guide Algorithm 1 Algorithm 2 Algorithm 3 Algorithm 4 BG Units/hr BG Units/hr BG Units/hr BG Units/hr Less than 70 follow hypoglycemia protocol Less than 120 off Less than 120 off Less than 120 Off Less than 120 Off Blood glucose 500 mg/dl or greater = consult provider [ ] POCT glucose Routine, Every hour, If result shows HI or LOW place stat serum glucose per written order. Continue hourly then modify order to frequency of every 2 hours once 3 consecutive blood glucose results within goal range (100 mg/dl 180 mg/dl) Page 3 of 6

4 Provider s Initial: [ ] insulin regular 1 unit/ml 100 ml infusion 1 Units/hr, IntraVENous, Titrated Goal of this protocol is to decrease glucose by mg/dl per hour Glucose Goal Range: 120 mg/dl to 180 mg/dl Initiating Insulin Drip: Algorithm 1: For patients who don't meet criteria for Algorithm 2 Algorithm 2: For CABG patients (current or past) or receiving glucocorticoids or on parenteral nutrition (TPN or PPN) or patients with diabetes receiving greater than a total daily dose of 80 units of insulin as an outpatient. Move to the algorithm to the right if deemed Algorithm failure Algorithm failure is defined as blood glucose above 180 mg/dl and the blood glucose has not decreased by at least 60 mg/dl within the past 1 hour. If both criteria are med begin using the next algorithm on the right. Please choose: Initial Algorithm {FHS HMC Insulin Algorithm Choices:25710} Discontinue all previous SQ insulin BG Less than 70 mg/dl follow Hypoglycemia Protocol Insulin Infusion Algorithm Guide Algorithm 1 Agorithm 2 Algorithm 3 Algorithm 4 BG Units/hr BG Units/hr BG Units/hr BG Units/hr Less than 120-Off Less than 120-Off Less than 120-Off Less than 120-Off Blood glucose 500 mg/dl or greater = consult provider [ ] ( Nutritional Insulin if patient eating) insulin aspart (NovoLOG) injection 3-6 Units, SubCutaneous, 3 times daily with meals **Nutritional Insulin If patient remains on insulin infusion while eating, do not adjust the infusion within 2 hours of giving insulin aspart, but continue to check BG every hour. Insulin aspart needs to be given before the meal or if uncertain that the patient will eat, give after. * If patient eats less than 50% of meal - give 3 units of insulin aspart subcutaneously * If patient eats greater than or equal to 50% of meal - give 6 units of insulin aspart subcutaneously Will this be administered via an insulin pump? Provider s Initial: Page 4 of 6

5 Hypoglycemia Panel When ready to stop infusion (i.e. Eating) Consider initiating Glycemic Control - Subcutaneous Addendum Physician Order #825. Note: Transition is smoother when BG values at goal for greater than 4 hours before insulin infusion is discontinued [X] Hypoglycemia protocol (with insulin infusion) [X] Hypoglycemia Protocol (with insulin infusion) [X] dextrose 50 % IV syringe 25gm/50ml Routine, Until discontinued, Starting S, 1) Goal is to keep blood glucose mg/dl 2) Turn off insulin infusion 3) If patient awake and able to take PO - give 4 oz. Of clear regular soda (i.e. Sprite) 4) If patient awake and unable to take PO - give 25 ml (1/2 amp) 50% dextrose in water (D50W) IV push 5) If patient obtunded (due to hypoglycemia) - give 50 ml (1 amp) 50% dextrose in water (D50W) IV push 6) Recheck blood glucose in 15 minutes 7) If blood glucose is less than 70 mg/dl, repeat hypoglycemic treatment 8) Recheck blood glucose every 30 minutes until great than or equal to 80 mg/dl 9) Resume hourly blood glucose checks once blood glucose is 70 or above 10) Notify physician if glucose remains less than 70 mg/dl after 2 doses of soda/dextrose or if recurrent episodes of hypoglycemia 11) Restart the infusion after blood glucose is greater than 120 mg/dl (decrease multiplier by 0.01) g, IntraVENous, As needed, low blood sugar, for blood sugar 69 mg/dl or less If patient is awake and unable to take PO, give 25 ml (12.5g). If patient is obtunded (due to hypoglycemia), give 50 ml (25g) IV push. ( )(X) glucagon DEXTROSE (human 10% recombinant) IN WATER (D10W) (GLUCAGEN) IV SOLP 1 mg, IntraMuscular, 500 Once, ml, when IntraVENous, indicated Continuous (remains on PRN, other, ( ) if injection 1 mg MAR), low blood sugar, feeding) For is blood discontinued sugar less or than reduced. 70 If patient unable to take Infuse PO at AND same no rate IV access., as previous Starting nutritional Today therap at 0944 Give glucagon 1 mg IM x 1 dose only. Turn patient on side as nausea and vomiting frequently occur. Notify provider. Obtain IV access and start D5W if deem appropriate by provider. Routine Page 5 of 6

6 Provider s Initial: D10W if Nutrition Reduced (Single Response) ( ) DEXTROSE 10% IN WATER (D10W) IV SOLP 500 ml, IntraVENous, Continuous PRN, other, if nutritional therapy (TPN or tube feeding) is discontinued or reduced. Infuse at same rate as previous nutritional therapy and notify provider. DATE TIME ORDERING PROVIDER PRINT NAME PROVIDER SIGNATURE DATE TIME RN ACKNOWLEDGED Page 6 of 6

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