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
- Management of hyperglycaemia in the clinically unwell patient
- Diabetic Ketoacidosis

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)
Blood glucose 5 to 14mmol/L		eGFR less than 30ml/min/1.73m^2: 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
Blood glucose >14mmol/L	No glucose	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