Protocols and Order Sets

Protocols and Order Sets

The order sets provided here are only a few examples from institutions involved in the management of inpatient hyperglycemia; this is not an all-inclusive list. Posting of these protocols does not constitute endorsement of any specific protocol. We believe that each institution should consult with diabetes experts to select and implement insulin protocols.

Key Points

  • Successful implementation of protocols requires:

    • Buy-in from key stakeholders (critical care physicians, house staff, nursing, pharmacy, hospital administration, etc)

    • Appropriate education through in-servicing of hospital staff

    • Ongoing monitoring of results

    • Support from endocrinologists for specific questions or when a patient does not respond to the protocol as expected

  • It is important to keep in mind that these algorithms have not been directly compared in clinical trials.

    • In selecting a protocol, one should look for characteristics that are compatible with the institution in which it will be implemented.

    • Consideration should be given to the following characteristics and whether these attributes will fit within the institution:

      • Is the protocol dynamic (ie, does it allow for variability in insulin requirements and account for rates of change in blood glucose concentrations)?

      • What is its relative user-friendliness and complexity?

      • To what extent does it require performance of basic calculations?

      • Is it compatible with the local computer systems?

  • None of the examples provided are suitable for the treatment of diabetic ketoacidosis.

ICU Protocols

Protocol

Updated Yale Insulin Infusion Protocol.
Available in: Shetty S, Inzucchi SE, Goldberg PA, Cooper D, Siegel MD, Honiden S. Adapting to the new consensus guidelines for managing hyperglycemia during critical illness: The Updated Yale Insulin Infusion Protocol. Endocr Pract. 2012;18:363-370.

University of Pittsburgh Medical Center (UPMC) Regular Insulin IV Infusion Protocol, Goal Blood Glucose 110-140 mg/dL.
Available in: Magaji V, Magaji V, Nayak S, et al. Comparison of insulin infusion protocols targeting 110-140 mg/dL in patients after cardiac surgery. Diabetes Technol Ther. 2012;14:1013-1017.

UPMC Regular Insulin IV Infusion Protocol, Goal Blood Glucose 140-180 mg/dL

UPMC Transition from Intravenous to Subcutaneous Insulin

UPMC Documentation of Hypoglycemia Treatment Protocol

Non-ICU Protocols

Protocol

UPMC Transition from Intravenous to Subcutaneous Insulin

UPMC Continuous Subcutaneous Insulin Pump Order Set

UPMC Documentation of Hypoglycemia Treatment Protocol

Pre-Operative Instructions for Patients with Diabetes

Inpatient to Outpatient Discharge Directions

Protocol

Diabetes General Home Care Discharge Instructions

Inpatient Diabetes Discharge Prescription