Neobook — clinical reference

Trade names:	Presentation and strength:
Actrapid Humulin R.	100u/ml (1000u/10ml vials).
Cautions: see SAMF.
Some insulin is absorbed by the PVC admin tubing – delivery may vary. Colloid facilitates better insulin delivery than normal saline. Insulin infusions in transit are inherently unsafe and should be discouraged, unless deemed essential by the referring or receiving doctor. See additional notes below.
Adult: 10u IV (0.1ml).	Paediatric: IV 0.025 to 0.1u/kg prn.
Commonly for 70kg adult: As above.	Neonatal:
Constant infusion:
Adult dosage range: 5 to 15u/hr.	Paediatric dosage range: 0.025 to 0.1u/kg/hr.
Adult dosage range: 5 to 15u/hr.	Neonatal dosage range:
Regime for 70kg adult:	Regime for paediatrics:
Mixture: Dilute 50u (0.5ml) in 50ml N/saline (1u/ml) 50u in 200 ml N/Saline (1u/4ml)	Mixture: 2.5u/kg in 50ml cristalloid.
Rate: Commence at 5 to 10ml/hr. Maximum 15ml/hr (for 1u/ml solution) Commence 24 ml/hr 1u/4ml solution in DKA	Rate: 0.5 to 2ml/hr.
Alternative adult regime:	Alternative paediatric regime:
Mixture: 100u (1ml) in 500ml colloid = 0.2 IU/ml.	Mixture:
Rate: Start at 25ml/hr. Maximum 75ml/hr.	Rate:
Additional notes:
In DKA, source control (antibiotics), hypovolaemia, acid-base and electrolyte disturbances (esp. serum potassium) are far more important than bringing blood sugar levels under control, in the short-term (managing the etiology of the DKA.) Insulin treatment without controlled potassium supplementation can result in potentially lethal hypokalaemia, and should not be undertaken without access to arterial blood gas and electrolyte monitoring facilities.
Other:
In DKA, if decrease in blood sugar level (BSL) is less than 4mmol/l/hr, double infusion rate every hour until decrease in BSL is greater than 4mmol/l/hr, or until BSL is less than 15mmol/l. When decrease in BSL is greater than 4mmol/l/hr, maintain insulin infusion at current rate until BSL is less than 15mmol/l.