Pilot Guideline for Glycaemic Control Using a Dynamic Subcutaneous Insulin Regimen (DSIR) on COVID-19 Critical Care Units

This guideline describes a management strategy for glycaemic control in adult Critical Care (level 2 and level 3 patients) during the COVID-19 pandemic for a selected group of patients, instead of using variable rate intravenous insulin infusion (VRIII) due to the limited availability  of syringe drivers.

There is a higher risk of dysglycaemia for patients with Covid-19 and pre-existing diabetes, and a higher risk of stress hyperglycaemia in those patients with Covid-19 without a history of pre-existing diabetes.

Inclusion criteria:

1. Patients with blood glucose >10 mmol/L (2 consecutive readings in 2 hours)
2. Patients on VRIII requiring 0-4 units/hour.

Exclusion criteria:

1. DKA/HHS- management as per relevant ICU guidelines
2. Type 1 diabetes/total pancreatectomy/ CF related diabetes:
   • For patients with  pre-existing type 1 diabetes, refer to the Insulin Use for Glycaemic Control on ICU guideline for the use of VRIII   consider continuing  the basal insulin (Insulatard®, Humulin I®, Insuman Basal®, Detemir (Levemir®), Glargine (Lantus®) or Degludec (Tresiba®) to avoid in-hospital DKA.
3. Patients on >100 units of insulin daily