Can softwareguided insulin dosing improve glucose control. Continuous infusion of subcutaneous compared to intravenous. This example illustrates a method for calculating of your backgroundbasal and bolus doses and estimated daily insulin dose when you need full insulin replacement. Softwareguided insulin dosing improves intrapartum. Improves compliance and reduces the risk of insulin dosing. The use of continuous subcutaneous insulin infusion csii and continuous glucose monitoring cgm systems has gained wide acceptance in diabetes care. Endotool glucose management system monarch medical technologies. Aug 28, 2018 monarch medical technologies granted u. Continuous infusion of subcutaneous compared to intravenous insulin for tight glycaemic control in medical intensive care unit patients. You will receive an email whenever this article is corrected, updated, or cited in the literature. This software program, known as the glucommander, has been used extensively by our group.
Monarch medical technologies announces new insulinonboard. Voluntis and monarch medical technologies announce. Comparison of computerguided versus standard insulin. Dosing software controls intravenous insulin administration.
Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Jun 20, 2018 voluntis and monarch medical technologies announce partnership to provide seamless solution for insulin dosing across the continuum of care. Pharmacology of intravenous insulin administration. Utilization of a computerized intravenous insulin infusion. Endotooltrade glucose management system is superior to conventional ivi dosing.
The hope is that a standardized, wellvalidated insulin dosing algorithm will lead to a decrease in rates of hypoglycemia and hyperglycemia by analyzing the data and providing efficacious. Jun 07, 2019 monarch medical technologies, the leader in precision insulin dosing for optimized inpatient glucose management, today announced u. It demonstrates comparable efficacy in lowering glucose along with a faster normalization of bicarbonate levels. Software guided insulin dosing decreases glycemic variability in critically ill patients more computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose is performed frequently and on time more. Voluntis and monarch medical technologies announce partnership to provide seamless solution for insulin dosing across the continuum of care providers can bridge the gap between inpatient and. Bolus high blood sugar correction also known as insulin sensitivity factor the bolus dose for high blood sugar correction is defined as how much one unit of rapidacting insulin will drop the blood sugar. Between 40% and 50% of that total dose should be administered as basal, with the rest dosed out in nutritional boluses. Softwareguided insulin dosing improves intrapartum glycemic. Caregivers are finally empowered to quickly modify a patients insulin. Her insulin dose had been increased to 450uhr but glucose levels were still ranging 500mgdl, at which point. Intravenous insulin dosing providing clinical decision support for intravenous iv insulin dosing, endotool iv is designed to safely and effectively address hyperglycemia and hypoglycemia with. October 19, 2007 medical decisions network mdn said yesterday it received fda 510k clearance for its mdncgs iv insulin dosing software for use by hospital nurses to quickly and accurately calculate the dosage of intravenous insulin administered to patients with elevated levels of blood glucose.
Endotool iv, a precision insulin dosing software application improves compliance and reduces the risk of insulin dosing endotool iv offers a straightforward software solution to recommend a personalized insulin dose when intravenous insulin. Consider a higher dose of dextrose 2 amps, 50 g or giving it with the insulin as a 4h infusion to decrease the incidence of hypoglycemia. Nov 01, 2019 patients should be aware of the differences between insulin and tuberculin syringes for measuring insulin doses, especially if prescribed u500 regular human insulin. Risk factors for hypoglycemia include intensive insulin therapy, use of an excessive insulin dose, improper timing of insulin administration with regard to meals, injection of the wrong type of insulin. The medical decisions network mdn mdncgs iv insulin dosing software computerizes insulin administration calculations and provides automated patient reports. The software aids in easy access to patient glycemic management information smartclick, early patient identification glucosurveillance, intravenous iv and subcutaneous subq dosing recommendations glucommander, and data analysis glucometrics. For patients who arent eating much, that calculation is likewise the total daily dose. According to the american diabetes association ada, a basal bolus plus correction insulin regimen is the preferred treatment for noncritically ill patients with good nutritional intake, and use of sliding scale insulin alone is strongly discouraged. You should give 50% of that total dose as basal insulin about four hours before patients iv insulin.
Glucommander diabetes care american diabetes association. Intravenous iv infusion is the preferred route of insulin delivery in critical care, labor and delivery, and perioperative inpatient settings because the rapid onset and short duration of action associated with iv infusion allow for matching insulin. Ajog 2018 examined whether the use of iv insulin dosing software in women requiring intrapartum insulin improved glucose management. The appropriate control of blood glucose in the icu is a demanding process complicated by the critical and complex patient who often presents with numerous comorbid conditions. Endotool iv, a precision insulin dosing software application improves compliance and reduces the risk of insulin dosing endotool iv offers a straightforward software solution to recommend a personalized insulin dose when intravenous insulin is administered to manage hyperglycemia. Administer 50% of tdi requirement as longacting insulin subcutaneously every 24 hours ii. Our group is attempting to construct an artificial pancreas based on intravenous glucose monitoring and intravenous insulin delivery.
This example illustrates a method for calculating of your backgroundbasal and bolus doses and estimated daily insulin dose when you need full insulin. Food and drug administration fda 510k clearance of an additional feature of monarch endotool subq, an insulin onboard iob algorithm. To do so, the pharmacology of intravenous insulin administration must be studied. Diabetes management software from glytec automates insulin. To describe indications for intravenous iv insulin infusion therapy and glycemic thresholds, discuss methods and protocols, and promote use of and access to iv insulin infusion therapy for all. You should monitor blood glucose levels hourly for 46h to match the 46h duration of regular insulin when given iv. Transitioning safely from intravenous to subcutaneous insulin glytec. Iv insulin leads to a dose dependent decline in serum potassium levels. Includes dosages for diabetes type 2 and diabetes type 1. When you receive a new supply of insulin, check the label to be sure if it is the correct type of insulin. These devices have been demonstrated to be clinically valuable, improving glycemic control and reducing risks of hypoglycemia in ambulatory patients with type 1 diabetes and type 2 diabetes. The device is intended for use with patients with no known insulin allergies and for patients.
Dosage of human insulin, which is always expressed in usp units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect. This program calculates an insulin drip rate based on the low and high blood glucose bg levels of the desired target range, the patients. The glucostabilizer software program indiana university health inc, indianapolis, in is a softwareguided insulin dosing system that calculates the dose of intravenous insulin that is needed based on metabolic parameters, target glucose concentration, and an individuals response to insulin. Kitabchi, phd, md 2 objective in this prospective, randomized, open trial, we compared the ef. The system contains clinical decision support tools and can be integrated with connected medical devices such as blood glucose meters, as well as. You place a nephrology consult for urgent dialysis and consider ordering calcium gluconate mg intravenously iv, albuterol 10 mg nebulized, insulin regular 10 units iv with dextrose 50% 25 grams. The appropriate control of blood glucose in the icu is a demanding process. Optimized glucose management with endotooltrade intravenous insulin ivi dosing introduction. Endotool iv offers a straightforward software solution to recommend a personalized insulin dose. The hope is that a standardized, wellvalidated insulin dosing algorithm will lead to a decrease in rates of hypoglycemia and hyperglycemia by analyzing the data and providing efficacious realtime dosing recommendations. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree. While the company, since its first fdacleared insulin dosing system was. To evaluate the safety and efficacy of glucostabilizer software intravenous insulin iv dosing in comparison to american diabetes association ada protocoldirected providerguided insulin dose adjustment pgia. The precision insulin dosing software, endotool glucose management system, makes complex insulin protocols, straightforward.
Combination therapy with im injection or cri of shortacting insulin plus sq injection of longacting insulin. Animal reproduction studies have been conducted with insulin glulisine in rats and rabbits using regular human insulin as a comparator. Calculation of subcutaneous insulin dose in those who have been on an iv insulin infusion is done by determining the tdd of insulin based on the patients insulin. A combination of iv insulin dose of 10 units plus 25 g of dextrose reliably lowers the serum potassium level by 1 meql. Fda clears mdncgs intravenous insulin dosing software. The glucostabilizer is a computerized intravenous insulin dosing software system that calculates insulin infusion rates for hospitalized patients with hyperglycemia. Glycemic control using intravenous insulin has been shown to improve outcomes in critically ill as well as noncritically ill patients. Insulin use in hospitalized patients with diabetes. Insulin recommended safe practice guidelines pharmacy purchasing 1. This is done by using the glucose sugar in the blood as quick energy.
Transitioning safely from intravenous to subcutaneous insulin. The injectable solution is also available in an overthecounter form called. This paper discusses the impact of the glucostabilizer program on the glycemic. This decision support system has a variety of fdacleared options including intravenous, subcutaneous, and pediatric insulin dosing algorithms. This protocol is not to be used for patients in diabetic ketoacidosis dka. Treatment of diabetic ketoacidosis with subcutaneous. Research design and methods a computerdirected algorithm for advice on the delivery of intravenous insulin that is flexible in blood glucose timing and advises insulin dosing in a graduated manner has been developed. Insulin dosing in hyperkalemia is it a one size fits all. Guidelines for insulin dose calculation no diagnosis of diabetes. Detailed insulin glargine dosage information for adults, the elderly and children. Consider using an insulin infusion for optimal control in this setting. Do not change the brand, type, or dose of your insulin unless your doctor tells you to. Intravenous insulin infusions can control hyperglycemia more efficiently than intermittent. The us food and drug administration has cleared new decisionsupport software that aids in insulin dosing.
There are various ways to transition patients with diabetes who are on an intravenous insulin infusion to subcutaneous insulin. Discontinue intravenous insulin infusion 2 hours after initial dose of lantus is given or 1 hour after initial humalog or regular insulin dose 8. Health, general blood glucose control measurement blood sugar critically ill health aspects critically ill persons hyperglycemia diagnosis drug therapy insulin pumps usage. Formulas commonly used to create insulin dose recommendations. Atotw 327 th perioperative insulin management 18 mar 2016 page 4 of 6.
Providing clinical decision support for intravenous iv insulin dosing. Many intravenous insulin protocols have been developed, such as the georgia hospital association protocol and the portland protocol. Managing hyperkalemia with insulinglucose journalfeed. Several reports of software guided insulin dosing have shown improved glycemic control while lowering hypoglycemia rates. The transition from intravenous iv to subcutaneous sq insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. Glytecs cloudbased software system provides personalized therapy and. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. The use of iv insulin infusion in patients who are eating or are receiving intermittent. With safe and personalized insulin dosing recommendations based on physiological patientspecific factors and individual patients response to treatment, endotool helps patients achieve glycemic control and optimize patient outcomes.
Insulin infusions should be continued until the patient is judged medically stable, off of vasopressors, and insulin. Intravenous dosage infusions prepared with insulin lispro 100 unitsml only. Calculating insulin dose diabetes education online. The egms diabetes management software system is built around the glucocommander set of fda approved proprietary dosing algorithms for intravenous. Insulin is one of many hormones that helps the body turn the food we eat into energy. The therapeutic options for such patients include adding a second or third oral agent or an injectable agent, such as a glucagonlike peptide1 glp1 receptor agonist or insulin, or switching to insulin.
Endotool iv insulin therapy monarch medical technologies. An intravenous insulin infusion in the hospital can be invaluable in an acutely ill patient on steroids and in any steroidtreated patient in whom the glucose values are persistently uncontrolled eg, 180 mgdl 10 mmoll and not responsive to initial increments in the insulin dose. Endotool glucose management system monarch medical. A pilot study evaluating this program suggested that patients. Commonly patients are treated with a bolus of regular insulin iv and then placed on an insulin infusion based on their weight maybe 6 units per hour. Insulin lispro intravenous route, subcutaneous route. Several case reports have also mentioned use of iv insulin.
Glucostabilizer calculates the dose of iv insulin required to reach a prescribed target glucose range. An iv infusion safety initiative focused on multidisciplinary collaboration, standardization of iv dosing, and medication safety technology. This study is a retrospective comparison of a computer decision support system glucommander for insulin dosing, versus conventional intravenous insulin protocol in dka management. Glycemic control is mandated in hospital care, yet the methodology to control blood glucose bg safely and effectively remains a clinical challenge. Tips for calculating a total daily dose of insulin today. Glargine insulin is the most physiologic basal insulin and is recommended in these patients. New software is being used by hospital nurses to quickly and accurately calculate the dosage of intravenous iv insulin administered to patients with elevated levels of blood glucose. The glucostabilizer software program indiana university health inc, indianapolis, in is a software guided insulin dosing system that calculates the dose of intravenous insulin that is needed based on metabolic parameters, target glucose concentration, and an individuals response to insulin. Jan 31, 2020 intravenous insulin infusions can control hyperglycemia more efficiently than intermittent subcutaneous insulin therapy and may be the preferred approach in certain settings, such as postcardiac surgery. Guidelines for insulin dose calculation no diagnosis.
The transition from intravenous iv to subcutaneous sq insulin in the hospitalized. Glucose levels will be evaluated by finger stick testing or blood testing 2. Monarchs endotool glucose management system offers personalized dosing recommendations for intravenous and subcutaneous insulin therapy. Glucose control in the critically ill patient utilizing. Transition from intravenous to subcutaneous insulin.
Integrated inpatient software for iv insulin management with the mission of improving glycemic control reduces the frequency, risk, and cost of hyperglycemia, hypoglycemia and glycemic varibility. The precision insulin dosing software, endotool glucose management system, makes. Fr0004183960 vtx, a company specialized in digital therapeutics, and monarch medical technologies, the leader in precision insulin dosing for optimized inpatient glucose management, today announced a new strategic partnership aimed at improving the coordination of glycemic management for patients. The system is programmed to provide intravenous dosing calculations of glucose or insulin.
The purpose of this study was to determine whether the use of intravenous insulin dosing software in women with pregestational. Utilization of a computerized intravenous insulin infusion program. The patients blood sugar is monitored hourly and the. The rationale for iv insulin during dka is that because of poor perfusion and consequently variable absorption of drug from the sq or im space iv cri of insulin allows for reliable and rapidly titratable dosing. The diabetes management software system is made up of a suite of modules that helps providers improve insulin dosing for the care of patients with acute diabetes, hypoglycemia and hyperglycemia. Insulin infusion may be an alternative to a basalbolus insulin regimen outside of. Gm is commercially available proprietary glucose management software that is prescriber directed and utilizes evidencebased multivariate algorithms to provide care teams with intravenous and subcutaneous insulin dosing recommendations. Iv insulin allows a safe dose of insulin to be administered on a continuous. Glytec llc adds pediatric insulin dosing to its iv. Comparison of an electronic glycemic management system versus.
Treatment of diabetic ketoacidosis with subcutaneous insulin aspart guillermo e. Jan 01, 2018 glytec eglycemic management system egms featuring glucommander algorithms is a cloudbased glycemic management system that offers hipaacompliant software for both the inpatient and outpatient setting. This proof of concept study was designed to evaluate the safety and effectiveness of an intravenous insulin dosing calculator, the clarian glucostabilizer program, and to determine the feasibility of its use as part of a glycemic control program. More hospitals are adopting measures to control elevated glucose levels commonly referred to. Iv shortacting insulin is the preferred treatment for this condition. The need for bedside calculation of insulin doses increases the risk of dosing errors. Our fdacleared decisionsupport software, insulin insights, removes barriers to treatment with insulin by providing patientspecific dosage adjustments in a matter of seconds. Keep insulin separate from tpn until a stable dose is reached. Regular insulin is recommended as the nutritional insulin. We used a pig model to determine the inherent lag time in the insulin blood glucose system. Jan 27, 2017 the egms diabetes management software system is built around the glucocommander set of fdaapproved proprietary dosing algorithms for intravenous, subcutaneous and pediatric administration of insulin. Adult transition from iv insulin to subcutaneous insulin pos pos mr147 r10.