06.04 Endo/Metabolic
06.04 Diabetes mellitus [PDF link]: T1DM, T2DM, Drugs used in DM & Insulin, DVLA rules for diabetes (driving), Complications of DM & sick day rules
Extra notes
Variable rate intravenous insulin infusion (VRIII)
Scales for insulin infusion rate
| Glucose (mmol/L) | Standard rate |
|---|---|
| 4.1-8.0 | 1 |
| 8.1-12.0 | 2 |
| 12.1-16.0 | 4 |
| 16.1-20.0 | 5 |
| 20.1-24.0 | 6 |
| >24.1 | 8 |
Fluids for VRIII
Recommended: 0.45% NaCl with 5% glucose and 0.15% KCl (20 mmol/L), or 0.45% NaCl with 5% glucose with 0.3% KCl (40 mmol/L)
Alternatives: 5% glucose with 20 mmol/L or 40 mmol/L KCl, or 0.18% NaCl with 4% glucose with 0.15% KCl (20 mmol/L), or 0.18% NaCl with 4% glucose with 0.3% KCl (40 mmol/L).
Management of inpatient hyperglycaemia
Even if patient is not on insulin, they may still require Novorapid for deranged sugars (eg steroid-induced hyperglycaemia)
Use local trust policy in the first instance, but most policies will offer similar guidance
If CBG >12 mmol/L, check ketones as well
If BM >12 mmol/L + ketones <3, then ask them to check again in 2h
If ketones are raised, activate DKA protocol
If in doubt always do a VBG to monitor pH
If remains raised (>12mmol/L) and ketones normal, then administer Novorapid according to CBG reading
12.0-16.9 mmol/L – 2U
17.0-20.9 mmol/L – 3U
21.0-24.9 mmol/L – 4U
25.0-27.0 mmol/L – 5U
>27.0mmol/L – 6U
If ≥2 correction doses are required in 24h, consider starting basal insulin or increasing basal insulin dose by 10-20%
Can be done temporarily if needed, eg in people with steroid-induced hyperglycaemia
Refer to diabetic nurses for further input as well
NB: BM = Boehringer Mannheim, a pharmaceutical company that developed the glucose test strip – it’s a very outdated term but still commonly used (“monitor BMs”). Not to be mistaken for bowel movements. Also used is CBG – capillary blood glucose, which is more accurate.
