Insulin Dilution Process
Question:
Does your center have a process in place, documentation, or handouts to support the use of dilute insulin in very young/insulin sensitive patients? Any documents or experience related to this would be helpful as we update and improve our process. Thank you!
Name: Whitney Beaton, MSN, RN, ACCNS-P, CDCES
Clinic: University of Wisconsin-UW Health Kids
Adult or Pediatric Population: Peds
Date: 11/1/2023
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Hi Whitney,
We did a QI project a couple of years ago related to diluted insulin and created some training materials. You can view our patient/family education handout from our website (“Diluted Insulin” under the ‘Insulin’ header): https://www.umpedsdiabetes.com/forms-handouts
Let me know if you have questions!
Best,
Ashley
This is so awesome, Ashley! I really appreciate you sharing! Thank you! Do you ever have patients admitted to the hospital using dilute insulin? We are working on our process in case this would happen, as well.
We love the resources from your center!
Whitney
Ashley, that resource page is amazing!!!
This is a copy of our protocol; there are photos, but I couldn’t get them to copy and paste here.
CLINICAL CONTEXT AND PURPOSE:
Provide guidance on the safe use of diluted subcutaneous insulin lispro (HUMALOG) 10 units/mL.
GUIDELINE RECOMMENDATIONS:
1. Diluted insulin is restricted to approval by Pediatric Endocrinology as required for patients with severe insulin sensitivity. Consult note is required, specifying need for use and details of administration needs.
2. Primary team to order via Ped Insulin Orderset (select all needed items except insulin) and collaborate with Pediatric Clinical Pharmacotherapy Specialist to place special order for Diluted Insulin if approved (ERX 2002443).
a. Adjust frequency times as needed to align with BG testing
b. Provide details for insulin calculation per default admin instructions.
3. Vials of diluted concentration of U-10 insulin lispro will be prepared in pharmacy using a combination of insulin lispro (HUMALOG) and Sterile Diluent for HUMALOG (U-100).
a. Compounding insulin lispro 10 units/mL (U-10):
i. Compound 50 units (0.5 mL) insulin lispro (HUMALOG) in 4.5 mL of Sterile Diluent for HUMALOG (U-100) in a 5 mL sterile empty vial. Label with a 14 day expiration date (room temperature) as MM/DD/YY.
4. Pharmacy to send diluted insulin U-10 vial with barcode to RN.
5. RN to prepare patient specific doses from vial per provider order in a 30-unit insulin syringe with ½ unit markings. CAUTION – SEE APPENDIX A for preparation instructions. Two RN independent verification required.
Appendix A:
Dose Ordered Amount of DILUTED INSULIN to Draw Up
Using Manufacturer Gradients*
0.05 units 0.5 units
0.1 units 1 unit
0.15 units 1.5 units
0.2 units 2 units
0.25 units 2.5 units
0.3 units 3 units
0.35 units 3.5 units
0.4 units 4 units
0.45 units 4.5 units
0.5 units 5 units
*MANDATORY: must use a 30-unit insulin syringe with 0.5 unit markings
DOSE will typically be less than 0.5 units. Please verify with provider if “DOSE ORDERED” is greater than 0.5 units to see if patient can be converted to standard insulin lispro concentration (100 units/mL).
REFERENCES:
LexiComp Online, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA: UpToDate, Inc.; July 30, 2021. https://online.lexi.com.
AUTHORS AND CONTRIBUTORS:
Joanna Tracy, PharmD, BCPPS (primary author)
Lydia Carson, MSN, RN, ACCNS-P, CCRN
Anasemon Saad, PharmD, BCPPS
HCH P&T APPROVALS:
P&T APROVAL:
MEDICAL BOARD APPROVAL DATE: