Therapeutic Handbook - GGC Prescribing

Insulin sliding scale, continuedPotassium SupplementationAim for a serum potassium of 4 - 5 mmol/L.Be guided on potassium replacement by U&Es:• If baseline potassium is > 5 mmol/L omit potassium replacement but continue to monitorpotassium and re-check U&Es in 4 hours.• Be prepared to vary the potassium chloride content of the IV fluids according to plasma potassiumlevels.• In patients with renal failure, chronic kidney disease or oliguria seek advice from a member of theRenal or Diabetes Team or Senior Medical Staff on potassium replacement.Supplementary Notes• Check capillary blood glucose hourly except when it is < 5 mmol/L and the sliding scale is stopped.In this instance check the capillary blood glucose every 30 minutes. When blood glucose levelsare stable capillary blood glucose levels can be checked every two hours.• When blood glucose levels are > 20.1 mmol/L it is important to assess the following:- Check pump devices, IV lines and IV cannulae to ensure patients are getting the prescribedinsulin dose- Consider other causes that could be contributing: sepsis, steroid therapy, obesity.Review the following at least twice daily (may need to be more frequent depending on the clinicalscenario):• Sliding scale and blood glucose response• Rate of infusion and type of fluid used• Potassium level and potassium supplementation.If you are unsure of how to review or how to adjust any of these parameters please contact amember of your local Diabetes Team. In patients with type 1 diabetes the sliding scale should onlybe discontinued once SC insulin (containing a long-acting insulin, such as a premixed or backgroundinsulin) has been restarted.Endocrine SystemPage 287