Dose: 0.14 unit/kg/hour IV alternatively, a bolus of 0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr has been used.Initiate insulin infusion 1 to 2 hours after starting fluid replacement therapy. Insulin therapy is used to slowly correct high glucose levels consult current treatment protocols for specific guidance on fluid and electrolyte management. Successful treatment of hyperglycemic emergencies such as diabetic ketoacidosis (DKA) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Usual Adult Dose for Diabetic Ketoacidosis Uses: To improve glycemic control in patients with diabetes mellitus U-500 insulin is for use in patients requiring more than 200 units of insulin per day. For people with type 2 diabetes, a patient-centered approach to care should guide choice of pharmacologic agents considerations include efficacy, cost, potential side effects, weight, comorbidities, hypoglycemic risk, and patient preference.Use HbA1c values to guide therapy consult current guidelines for optimal target ranges.Initial doses are often in the range of 4 to 6 units or 0.1 units/kg or 10% of basal insulin dose.Continuous Subcutaneous Insulin Infusion (CSII) Insulin Pump Therapy: Use of regular insulin (U-100) is not recommended because of the risk of precipitation use of concentrated insulin (U-500) has not been studied and is not recommended.Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), changes in renal or hepatic function, changes in medications, or during acute illness to minimize the risk of hypoglycemia or hyperglycemia.During changes to a patient's insulin regimen, increase the frequency of blood glucose monitoring.Patients should be instructed to always check insulin label prior to administration to confirm the correct insulin product is being used.The safety and efficacy in combination with other insulins has not been determined.Administer U-500 insulin subcutaneously 2 to 3 times a day approximately 30 minutes prior to start of a meal.Insulin U-500 (Humulin R U-500): For subcutaneous administration only Novolin R: Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags this insulin is stable in normal saline, 5% dextrose, or 10% dextrose with 40 mmol/L potassium chloride.Humulin R: Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags this insulin is stable in normal saline.INTRAVENOUS Administration: Administer only under medical supervision with close monitoring of blood glucose and serum potassium Insulin U-100 should generally be used in a regimen with an intermediate or long-acting (basal) insulin.SUBCUTANEOUS Administration: Inject subcutaneously approximately 30 minutes prior to a meal Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day.Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500)ĭoses should be individualized based on patient's metabolic needs, blood glucose monitoring results, and glycemic goals
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