Adult:
As soluble insulin, given in concentration of 1 unit/ml using an infusion pump: Initially infuse at a rate of 6 units/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/l/hr. If blood glucose concentrations have decreased to 10 mmol/l, reduce the infusion rate to 3 units/hr and continue with 5% glucose to prevent hypoglycaemia, until the patient can eat orally. Do not stop the insulin infusion before SC insulin is started. Ensure adequate fluid replacement and include potassium chloride in the infusion to prevent insulin-induced hypokalaemia.
Intravenous
DIABETIC KETOACIDOSIS
Child:
As soluble insulin, given in concentration of 1 unit/ml using an infusion pump: Initially infuse at a rate of 0.1 units/kg/hr, double or quadruple the rate if blood glucose concentration do not decrease by about 5 mmol/l/hr. If blood glucose concentrations have decreased to 10 mmol/l, reduce the infusion rate to 0.05 units/kg/hr and continue with 5% glucose to prevent hypoglycaemia, until the patient can eat orally. Do not stop the insulin infusion before SC insulin is started. Ensure adequate fluid replacement and include potassium chloride in the infusion to prevent insulin-induced hypokalaemia.
Intramuscular
DIABETIC KETOACIDOSIS
Adult:
As soluble insulin, initial loading dose of 20 units, followed by 6 units/hr until blood glucose drops to 10 mmol/l, when the dose is given 2 hrly.
Subcutaneous
DIABETES MELLITUS
Adult:
Admin according to requirements; inject into thighs, upper arms, buttocks, or abdomen
Precautions
Pregnancy (insulin requirements tend to fall during the 1st trimester, increase during the 2nd and 3rd) and lactation. Regular monitoring of HbA1c and blood glucose concentrations.
