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- Discussion:
    - indicated for resistant hyperglycemia or DKA;
    - patients treated with the insulin drip typically need 0.3 to 0.4  of insulin per gram of glucose per hour;
           - hence, D5W at 100 ml/hr (5 gm/hr) requires 1.5 to 2.0 U/hour of insulin;
- Method of Delivery:  
    - note that Regular Insulin can bind to the plastic IV tubing;
    - 30-50 ml of the infusion solution should be run thru IV tubing & discarded, before the IV tubing is attached to patient;
    - albumin may be added to bind insulin and decrease binding of insulin to solution containers;
- Precautions:
    - is possibility of cerebral edema if B.G. is lower from acutely high levels to normal in 2 to 4 hours;
    - attempt instead to lower blood glucose at or above 250 for several hours before lowering it to normal, as this will help to avoid 
             cerebral edema;
- General insulin drip:
    - 10 units of regular insulin in 1 liter of D5W at 100 to 200 cc/hr;
    - will get good results w/ 1 unit Insulin/hr IV or 100 cc/hr;

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                 Blood Glucose     Rate           "A" Insulin    "B" Insulin
                     (mg/dl)         (ml/hr)                (U/hr)             (U/hr)
                     0 -  50           5                    0.25               0.50
                     5 - 100          10                    0.50               1.00
                   100 - 150          15                    0.75               1.50
                   150 - 200          20                    1.00               2.00
                   200 - 250          25                    1.25               2.50
                   250 - 300          30                    1.50               3.00
                   300 - 350          35                    1.75               3.50
                   350 - 400          40                    2.00               4.00
                          > 400       50                    3.00               6.00

Alternative method:
   - start IV infusion of 5% destrose in water at the rate of 50 ml/hr until patient is taking solid food;
   - piggy back to dextrose infusion an infusion of regular insulin using IVAC;
   - preparation of the insulin solution: 50 units in 250 ml of 0.9% NS;
   - flush 60 ml of infusion mixture thru system and discard before attaching
   - set infusion rate: Insulin (units/hr) = (plasma glucose mg/dl)/ 100 (divide by 150 if pt is thin or is not on Steroids)
   - regular insulin 25 units in 250 ml of NS (1 unit/10 ml)
   - flush 50 ml thru line before connecting to patient;
   - piggyback insulin line to the perioperative maintenance fluid line;
   - fluids should contain D5W (100 ml/hr)