Complicating factors

There are two areas of concern when administering intravenous glucose and insulin therapy. These are:

• the plasma potassium concentration should be monitored and the infusion altered accordingly:
  
  
• Potassium concentration; Potassium supplement to each litre of 10% dextrose
• < 3.5 mM; 40 mmol
• 3.5 - 5.0 mM; 20 mmol
• > 5.0 mM; 0 mmol
  
  
  
  
• higher levels of insulin will be required in the following circumstances:
  • severe infection
  • in cardiac surgery where the bypass pump is primed with dextrose
  • if an adrenergic agent is used
  • if parenteral nutrition is employed
  • if adreno-suppressive doses of corticosteroids are in use

Ref: Robinson, R. and Stott, R., Medical Emergencies: Diagnosis and Management, 1993, 6th edition, Butterworth-Heinemann, p.172-3