IV Insulin Infusion and Titration Protocols

An IV regular insulin infusion is used when glucose must be lowered in a controlled, rapidly adjustable way. The infusion is not a response to one isolated elevated reading. In hospitalized adults, it is generally started when capillary or plasma glucose is at least 10 mmol/L on two separate measurements within 24 hours. For critically ill patients, the usual target is 7.8–10.0 mmol/L. The aim is controlled glucose management, not immediate normalization. Driving glucose too low creates a more immediate danger than modest hyperglycaemia: neuroglycopenia, seizures, dysrhythmias associated with electrolyte shifts, and inability to detect symptoms in sedated or ventilated patients. IV insulin acts quickly, so the nurse can respond to changing physiology hour by hour. That same speed makes it high risk. A rate that was appropriate before an enteral feeding interruption, improvement in sepsis, or decline in renal function may become excessive soon afterward.