Regimens must be individualized.

If the patient is already receiving a long-acting insulin analogue, this should be continued.

Obese patients require more insulin per hour because of insulin resistance.Capillary blood glucose (CBG) measurement should be used to determine the initial insulin infusion rate, and checked hourly to ensure that the infusion rate is appropriate.

1. Make 50 units of soluble insulin up to 50 mL with normal saline (i.e. 1 unit/mL). Flush 10 mL of the solution through the line before connecting to the patient (as some insulin will be adsorbed onto the plastic).
2. Check blood glucose and start the insulin infusion at the appropriate rate (see below).
3. Administer 1L of 0.45% saline with 5% glucose at 125 mL/h IV (83 mL/h if heart or renal failure).
4. Co-administer potassium chloride IV at an appropriate rate if plasma potassium is <5.5 mmol/L.
5. Check
   capillary blood glucose (CBG) hourly. Adjust the insulin infusion rate as needed, aiming to keep blood glucose between 6 to 10 mmol/L.
   • If CBG is within the target range or falling towards it, continue same rate of insulin infusion.
   • If CBG remains over >12 mmol/L for 3 consecutive readings and is not dropping by 3 mmol/L/hr or more the rate of insulin infusion should be increased.
   • If CBG drops to below 4.0 mmol/L, the insulin infusion should be stopped and hypoglycaemia should be treated irrespective of whether the patient has symptoms. Insulin infusion should be restarted at a stepped-down rate once CBG is >4.0 mmol/L.