Intraoperative Insulin Management Protocol (Cleveland Clinic)
Intraoperative Insulin Management Protocol (Cleveland Clinic)
Starting insulin:
Start if pre-CPB blood glucose > 120 mg · dL−1 (6.6mmol/l) and if on-pump or post-pump blood glucose > 150 mg · dL−1. (8.33mmol/l).
Bolus dose:
0.03 units · kg−1 (maximum bolus is 3 units).
Initiate continuous infusion: initial rate 0.03 units · kg−1 · h−1 (maximum initial rate is 3 units · h−1). See Table below
1. Blood glucose monitoring
Measure blood glucose every 30 to 60 minutes.
2. Hypoglycemia protocol
If blood glucose ≤ 60 mg · dL−1 (3.3mmol/l): stop insulin infusion, give 25-50 mL of 50% dextrose solution, obtain blood glucose level every 30 minutes until blood glucose >80 mg · dL−1 (4.4mmol/l) for three consecutive levels, then check blood glucose every 30-60 minutes.
If blood glucose 60-70 mg · dL−1 (3.3-3.8mmol/l), or 71-85 mg · dL−1 and decreasing: stop insulin infusion, obtain blood glucose level every 30 minutes until blood glucose > 85 mg · dL−1(4.7mmol/l) for three consecutive measurements, then check blood glucose every hour.
3. Resuming insulin infusion
Restart at half the previous rate when blood glucose rises above 150 mg · dL−1 (8.3mmol/l).
