Critical Care Insulin Calculator

COVID-19 Quick Reference

Select current status:

For patients not currently on an insulin infusion or if insulin has been stopped and is due to be restarted:

Current blood glucose [mmol/L]

Does your patient have enteral feed or a glucose containing IV fluid running?

No

Yes

Advice:
Intravenous insulin infusions require background nutrition to avoid hypoglycaemia. If enteral feed is interrupted arrange immediate glucose containing IV maintenance fluid. If no background feed or glucose containing fluid is available stop IV insulin and request urgent clinical review from the medical team.

If background nutrition is available, change the slider above to 'Yes' to activate the calculator.

For patients currently on an insulin infusion

Current blood glucose [mmol/L]

Previous blood glucose [mmol/L]

Current Insulin rate [ml/hr of 1 iU/ml]

Does your patient have enteral feed or a glucose containing IV fluid running?

No

Yes

Advice:
Intravenous insulin infusions require background nutrition to avoid hypoglycaemia. If enteral feed is interrupted arrange immediate glucose containing IV maintenance fluid. If no background feed or glucose containing fluid is available stop IV insulin and request urgent clinical review from the medical team.

If background nutrition is available, change the slider above to 'Yes' to activate the calculator.

Code copied to clipboard: use Ctrl-V to paste into EPR.

Higher threshold for starting IV insulin than usual

If blood glucose > 12 mmol/L recheck in 1-2 hours

If blood glucose remains > 12 mmol/L start IV insulin

Target blood glucose range 6-12 mmol/L

Using 50 units Actrapid in 50mls saline (prefilled where available)

Calculate starting rate

Using calculator at saferinsulin.org, app or local version

Record calculator reference code in casenotes unless other clinical priorities

Use paper VRII if not trained

Check blood glucose every 1-2 hours

Whilst IV insulin requires 1 hourly checks, should other clinical
demands take priority this can safely be extended to 2 hourly

Calculate dose adjustment

Using calculator or from paper VRII if not trained

Hypoglycaemia is a clinical emergency

Ensure PRN 50ml of 50% glucose or alternative emergency treatment
is easily accessible at all times where IV insulin is being delivered.

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About this tool

https://lomas.doctor
Full source code on Github

Contributors:

Dr JP Lomas
Dr Rhodri Harris
Dr Tony Thomas

Supported by:

Funded by:

Last build: Sun Jul 18 2021 10:32:16 GMT+0000 (Coordinated Universal Time)

For use when trained and with consultant permission

MIT license
Permission is hereby granted, free of charge, to any person obtaining a copy of this software and associated documentation files (the "Software"), to deal in the Software without restriction, including without limitation the rights to use, copy, modify, merge, publish, distribute, sublicense, and/or sell copies of the Software, and to permit persons to whom the Software is furnished to do so, subject to the following conditions:

The above copyright notice and this permission notice shall be included in all copies or substantial portions of the Software.

THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.

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Safer Insulin for Adult Critical Care

Select current status:

Hyperglycaemia in critically unwell adults with COVID-19

About this tool

Safer Insulin
for Adult Critical Care