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Updated: Jun 26, 2026

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Hyperglycemia during acute coronary syndrome: a nurse-managed insulin infusion protocol for stricter and safer
Fausto Avanzini1, Giuseppe Marelli, Walter Donzelli
1Division of Cardiology and Coronary Care Unit, General Hospital, 20033 Desio (MI), Italy. avanzini@marionegri.it
Background:
Diabetic patients with acute coronary syndromes (ACS) might benefit from tight glycemic control by means of insulin infusion. Nurse-implemented insulin infusion protocols (IIP) are available but none validated in patients with ACS admitted to a coronary care unit (CCU).
Aims:
To assess feasibility, effectiveness and safety of a new nurse-managed IIP (Desio Diabetes Diagram, DDD) for intensive glucose control in patients with suspected ACS and known diabetes or blood glucose (BG) >200 mg/dL.
Methods And Results:
To reach and maintain a target BG level of 100-139 mg/dL we adopted a nomogram based on the percent changes in the insulin infusion rate according to the current BG value and the percent change from previous BG level. Ninety-one consecutive patients (53 men, mean age 69.7+/-11.2 years) were treated with DDD IIP. Baseline BG was 202.2+/-86.8 mg/dL. The median time to achieve the target was 3 h (Q1-Q3 2-5 h). Afterwards target BG levels were maintained for 70.4+/-15.9% of the time. During 5004 h of insulin infusion BG never fell below 40 mg/dL.
Conclusions:
The nurse-managed DDD IIP was easily implemented in our CCU and permitted strict and safe glycemic control in hyperglycemic patients with ACS.
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