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Insulin Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Insulin syringes MUST be used when drawing up insulin
- On most occasions, insulin is given by the subcutaneous route
- For single patient use only (not to be used in multiple patients)
- When opening vial, attach patient addressograph to flag label, and write date of opening on label
- For Y-site compatibility see below
- See prescription sheet
Insulin syringes must be used to draw up insulin- these are the orange-capped syringes, graduated in units |
Available preparations
Actrapid 100 units per 1ml (i.e. 1,000 units in a 10ml vial)
NovoRapid 100 units per 1ml (i.e. 1,000 units in a 10ml vial)
Reconstitution
Already in solution
Infusion fluids
Sodium chloride 0.9%
Methods of intravenous administration
Continuous intravenous infusion using a syringe driver (If a patient is being transferred between wards/units, the syringe driver must not be disconnected, but must be transferred with the patient)
- Usual concentration used is 50 units Actrapid insulin (draw up using insulin syringe) in 50ml Sodium chloride 0.9%( to produce a final concentration of 1 unit per ml) (ref 2)
- Ensure that the needle injecting the insulin is longer than the injection port dead-space (ref 2,3)
- Invert the syringe several times after addition of insulin, to ensure even distribution of the insulin. (ref 3)
- Before beginning the infusion, prime the entire administration set with the prepared solution of insulin (ref 3)
Slow intravenous injection (HYPERKALAEMIA- as per hospital guidelines) (ref 1)
- See under DOSE
Dose in adults
Usual dose
- Rate adjusted according to blood glucose monitoring
- Generally 0.3 to 1 unit/kg/day
- See Q pulse guidelines on the use of intravenous insulin in
Hyperkalaemia (ref 1)
- Insulin administration varies depending on baseline glucose and on renal function
- See GUH guideline for hyperkalaemia management (adults) for full details. Information below relates to the Novorapid aspect of the guideline only
| GUH guide to hyperkalaemia management (adults) | ||
|---|---|---|
| Blood glucose level | Glucose dose | Insulin dose |
| Blood glucose less than 5mmol/L | Glucose 50% x 50ml over 15 minutes | NO INSULIN |
| Blood glucose 5 to 14mmol/L | Add required dose insulin to 50ml Glucose 50% and administer over 15 minutes |
eGFR greater than 30ml/min/1.73m2: NovoRapid insulin 10 units IV added to Glucose 50% 50ml over 15 minutes Draw up Novorapid insulin using an insulin syringe (checking with another healthcare worker) |
|
eGFR less than 30ml/min/1.73m2: NovoRapid insulin 5 units IV added to Glucose 50% 50ml over 15 minutes Draw up Novorapid insulin using an insulin syringe (checking with another healthcare worker) |
||
| Blood glucose >14mmol/L | No glucose |
eGFR greater than 30ml/min/1.73m2: NovoRapid insulin 10 units IV Draw up Novorapid insulin using an insulin syringe (checking with another healthcare worker). Add to 10ml Sodium chloride 0.9%, mix well and administer as an IV push |
|
eGFR less than 30ml/min/1.73m2: NovoRapid insulin 5 units IV Draw up Novorapid insulin using an insulin syringe (checking with another healthcare worker). Add to 10ml Sodium chloride 0.9%, mix well and administer as an IV push |
||
Renal or hepatic impairment
- Insulin requirements may be reduced - monitor closely
Further information
- Some loss of insulin can occur during intravenous administration using plastic infusion systems - to minimise this occuring prime line prior to infusion with a small quantity of insulin infusion, and monitor clinical response during infusion, including blood glucose (ref 3)
- Insulin is more often given by the subcutaneous route in GUH- see 'GUH Subcutaneous INSULIN & Glucose Monitoring record' sheet
- See also GUH policy on Prescribing, Storage and Administration
Storage
- Store between 2 to 80C until the vial has been opened
- Once opened, the product should be stored at room temperature
- Do not freeze, either prior to opening, or when the vial is in use
- When opening vial, attach patient addressograph to flag label, and write date of opening on label
- Prepared infusion should be used within 24 hours
References
Novorapid SPC 09/2020
Actrapid SPC 09/2020
1:CLN-60 GUH guide to hyperkalaemia management (adults) Dec 2023
2. Injectable Medicines administration guide Medusa, downloaded 26th Feb 2019
3. The compatibility of insulin in intravenous infusions NovoNordisk 2008
4: CLN-DIAB-005 -GUH Guidelines for Management of Diabetic Ketoacidosis in Adults
5. CLN-DIAB-8 - GUH Hyperglycaemic Hyperosmolar Nonketotic State Protocol
Therapeutic classification
Actrapid: Short-acting human insulin Novorapid: Short-acting human insulin analogue