Insulin for Hyperosmolar Hyperglyemic Syndrome Protocol

The initial goal of insulin therapy is to decrease blood glucose slowly by 2.8-4.2 mmol/L per hour.
Discontinue all previous orders for insulin and other glucose lowering agents.
Patient must be NPO and remain in unit, unless accompanied by a nurse or physician while infusion is running.
Contact physician if K < 3.5 mEq/L prior to starting infusion.
Insulin solution is 1 unit of regular insulin per 1 ml of 0.9% NaCl.
Initial insulin bolus is 0.1 units/kg.
Initial insulin dose is 0.1 units/kg per hour.
Monitor patient's finger stick blood blood glucose every hour.
Adjust the infusion rate based on the previous blood glucose, current blood glucose and current infusion rate.
Stop insulin infusion if blood glucose <= 3.8 mmol/L and initiate hypoglycemia protocol by giving 50 mL of 50% Dextrose, by calling the physician and checking blood glucose every 15 minutes until above 3.8 mg/dL.

Initial Insulin Bolus and Dose


Calculator for Insulin Dosing Adjustment