INSULIN (Neutral)

Actrapid Penfill

Reviewed by Dr Carl Kuschel, Robyn Wilkinson, and Brenda Hughes
February 2002
Administration details updated July 2002
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

 

Management of  Insulin Administration

Description

Prescription

Continuous Infusions:

Charted on fluid chart giving:

Also charted on drug chart under continuous infusions

SC/IM Injection:

Charted on the prescription chart:

Administration of Insulin

Continuous IV Infusion:

Note:  Insulin infusion is not to be filtered.

First dilution (1 unit/ml):

  1. Dilute 50 units (0.5 ml) of insulin into 49.5 ml D5W to make a solution of 1 unit/ml. Mix well.
  2. Using a 5 ml syringe draw up required amount of insulin (1 unit/ml) as charted.
  3. Discard the remainder of the 50ml syringe of insulin (1 unit/ml).

Second dilution

  1. With another 50ml syringe draw up D5W at an amount to make the solution to a total of 50ml.
  2. Add the insulin dose (1 unit/ml from the 5ml syringe.  Mix well.
  3. Prime the BC 566 (no filter is required).
  4. Leave syringe and extension for 1 hour to saturate the plastic binding sites.
  5. Flush a further 20ml of the prepared solution into a gallipot.
  6. Connect to a continuous infusion pump and then to infant.
  7. Change solution and tubing every 24 hours.

SC/IM Injection:

  1. No dilution required.

Observation and Documentation

  1. Monitor blood glucose frequently (initially 1-2 hourly until stable).
  2. Check urine for glucose at least 4-hourly.
  3. Monitor for signs of hypoglycaemia.
  4. Notify doctor / NS-ANP immediately if dextrose or intravenous nutrition infusion is interrupted e.g. tissued drip. Insulin infusion may need to be discontinued until dextrose infusion is restored.
  5. When insulin is in the IVN or dextrose infusion, a separate cannula will be required for IV medications.

Storage

Selected References

1 Pildes RS. Neonatal Hyperglycaemia. J Pediatr 1986; 109:905-7.
2 Ostertag SO, Jovanovil L, Lewis B, Auld PAM. Insulin pump therapy in the Very Low Birthweight Infant. Pediatrics 1986; 78:626-30.
3 Collins JW, Hoppe M, Brown K, et al. A Controlled trial of Insulin Infusion and Parenteral Nutrition in Extremely Low Birthweight Infants with Glucose Intolerance. J Pediatr 1991; 118:921-7.
4 Paediatrician/Senior Nurse Meeting, National Women’s Hospital. 20.02.97
5 Hewson et al.  Insulin infusions in the neonatal unit: delivery variation due to adsorption.  J Paed Child Health 2000;36:216-220.