Appendix 5 Table 1

Appropriate action depending on blood glucose level

Test

Blood glucose result (mg/dl)

Action

A: Measure blood glucose on entry to ICU

>220

Start insulin at a dose of 2–4 IU/h. Continue as per test B

220–110

Start insulin at a dose of 1–2 IU/h. Continue as per test B

<110

Do not start insulin but continue blood glucose monitoring every 4 h. Continue as per test A

B: Measure glucose every 1–2 h until in normal range

>140

Increase insulin dose by 1–2 IU/h

110–140

Increase insulin dose by 0.5–1 IU/h

Approaching normal range

Adjust insulin dose by 0.1–0.5 IU/h. Continue as per test C

C: Measure glucose every 4 h

Approaching normal range

Adjust insulin dose by 0.1–0.5 IU/h

Normal

Leave insulin dose unchanged

Falling steeply

Reduce insulin dose by half and check every 1–2 h

60–80

Reduce insulin dose and check blood glucose within 1 h

40–60

Stop insulin infusion, assure adequate baseline glucose intake and check blood glucose within 1 h

<40

Stop insulin infusion, assure adequate baseline glucose intake, administer glucose per 10 g IV boluses and check blood glucose within 1 h

Vincent et al. Critical Care 2002 6(Suppl 3):S1   doi:10.1186/cc1860