Neonatal Critical Care Hyperglycemia Management Guideline
Recommended initial action for hyperglycemia

Reduce glucose infusion rate (GIR) to 4-6 mg/kg/min. Recheck blood glucose
(BG) hourly. If BG remains >200 x 2, proceed to insulin guideline.
Eligibility criteria for insulin


BG > 200 mg% x 2 (separate each sample by 1 hour)
Patients with neonatal diabetes mellitus should not be managed with this
guideline.
Recommended initial insulin dose



Begin a continuous IV drip of insulin at 0.05 units/kg/hour
Maximum rate allowed by this guideline: 0.5 units/kg/hour
Insulin bolus doses are not recommended for BG titration in this guideline.
Recommended BG sampling




Measure BG every hour while on insulin until BG is stable.
Sampling frequency may be reduced by provider order if BG 101-150 mg% for
at least 6-12 hours with no dosing adjustments required.
After insulin is stopped, sample BG every 2 hours x 2, then every 4 hours x 3.
Draw BG samples from an arterial line, heel stick, or central venous line. Do
not draw samples from lines that infuse a dextrose-containing fluid. Clamp the
dextrose-running lumen if sampling from a double lumen line.
Recommended management guide
BG (mg%)
<60
60-100
101-150
151-200
>200
Recommendation
Stop/Suspend insulin, administer 2 mL/kg of 10% dextrose, notify
NNP or neonatologist, then re-sample BG in 30 minutes
Stop/Suspend insulin then notify NNP or neonatologist
Stop/Suspend insulin
Computer titrated target range while on insulin drip
Computer adjusts insulin drip more aggressively to lower BG
Guideline finalized: August 21, 2015
Cerner rules for neonatal critical care hyperglycemia
Insulin drip is ON
BG
Result
Insulin drip is OFF
<60
 Administer 2 mL/kg 10% dextrose,
 Notify NNP or neonatologist, then
 Re-check BG in 30 minutes




Stop/Suspend insulin,
Administer 2 mL/kg 10% dextrose,
Notify NNP or neonatologist, then
Re-check BG in 30 minutes
 Notify


Stop/Suspend insulin, then
Notify NNP or neonatologist

Stop/Suspend insulin
60-100
101-150
151-200
NNP or neonatologist
Insulin not recommended
Insulin not recommended
BG drop
<25 mg%/hr
or increase
Continue
same insulin
dose
BG drop
26-74
mg%/hr
Decrease
insulin dose
by 25%
Other
BG drop
>75 mg%/hr Recommendations
If insulin rate < 0.02
Decrease
units/kg/hr, stop insulin
insulin dose by and measure BG Q2
hours x 2, then Q4
50%
hours x 3
201-250
 If no previous BG >200 within a 45
min to 2 hour time frame, use
Conditional Order to repeat glucose
in 1 hour
 If 2 successive BG >200 within a 45
>250
Increase
insulin by 25%
Continue
same insulin
dose
Decrease
insulin dose by
50% and notify
NNP or
neonatologist
Continue
same insulin
dose
Decrease
insulin dose by
50% and notify
NNP or
neonatologist
Increase
min to 2 hour time frame, “Notify NNP
insulin dose by
or neonatologist that insulin is
50%
and notify
recommended in this patient per
NNP or
protocol.”
neonatologist
Maximum rate
allowed is 0.5
units/kg/hr
Guideline finalized: August 21, 2015