n Southern African Journal of Critical Care - Insulin administration for the control of blood glucose in the adult ICU - an evidence-based guideline : guideline

Volume 23, Issue 1
  • ISSN : 1562-8264
  • E-ISSN: 2078-676X



The South African Critical Care Nurses Forum identified the development of practice guidelines as an urgent priority. This guideline, which marks the beginning of this process, aims to present evidence-based recommendations for the administration of continuous infusions of intravenous insulin for the control of blood glucose in critically ill adult patients.

A wide range of databases was searched including Medline, CINAHL and the Cochrane database. Further references were obtained from the reference lists of relevant articles and Lilly Laboratories provided data relating to the stability of insulin in solution and storage recommendations. Expert knowledge and experience were also considered. The data were graded according to the strength of evidence and recommendations made for clinical practice.
These recommendations include using isotonic saline as the carrier, not preparing solutions in advance, remixing every 12 hours and priming the syringe and tubing before use. The use of a protocol is advisable but this is dependent on accurate measurement of blood glucose by properly trained staff. Capillary blood is adequate for most patients except for those who are in shock and on vasopressors. The signs of hypoglycaemia and hypokalaemia and the management of these complications are included.

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