|Reviewed & Approved by
Clinical Practice Committee
- Continuous IV infusion: 0.01 - 0.1 U/kg/hr
(starting dose usually 0.05 U/kg/hr). Titrate infusion rate according to
blood glucose response.
Infusion should not be included in the daily
prescribed fluid total. Insulin should be given in addition to daily
Insulin (units of 1 Unit/ml dilution) to be added to 50ml =
50 x weight
(kg) x dose (units/kg/hour)
IV rate (ml/hr)
- Intermittent dose: 0.1-0.2 U/kg 6-12 hourly SC/IM.
- Hyperglycaemia in VLBW infants with persistent glucose intolerance.
- Hyperkalaemia in critically ill VLBW infants.
Contraindications and Precautions
- May rapidly induce
- Hypersensitivity to insulin (extremely rare).
- Insulin resistance may develop causing a larger dose requirement.
Insulin enhances uptake of glucose
in insulin sensitive tissues, enhances glycogen and fat synthesis, enhances
muscle uptake of amino acids and cellular uptake of potassium. It inhibits
lipolysis and gluconeogenesis. Plasma half-life is short (approximately 9
minutes in adults), with degradation in liver and kidneys. Absorption from IM or
SC doses is variable.
Possible Adverse Effects
- If the blood glucose concentration is:
- < 4.0 mM consider stopping insulin or at least halve the insulin
- < 2.6 mM stop insulin, consider dextrose bolus
- Check blood glucose concentration again in 1 hour
- If given by infusion, should be via a line that will not
need to be flushed (to avoid boluses) and ideally the same line as is used for
dextrose or intravenous nutrition infusion. This ensures cessation of insulin at
the same time as glucose infusion if the drip tissues, and thus reduces the risk
- Incompatible with aminophylline, chlorothiazide,
dobutamine, lignocaine, phenobarbitone, phenytoin, sodium bicarbonate.
- Effect decreased by drug-induced hyperglycaemia e.g.
corticosteroids, thiazide diuretics, adrenaline, glucagon, thyroid preparations, phenytoin.
- Adsorbs onto plastic i.e. syringes, extension tubing, filters, and 3-way taps.
- Is considered safe by National Women’s Hospital Paediatricians to mix
insulin and heparin in the same syringe for administration via a central venous line.