A guideline for the use of variable rate intravenous insulin infusion (VRIII) in medical inpatients

Abstract

A variable rate intravenous insulin infusion (VRIII) is used commonly to achieve normoglycaemia in hospital inpatients. Most acute trusts in the UK have VRIII guidelines, but there is wide variation in the indications for its use, in rates of infusion, and in duration of use. This heterogeneity increases the risk of errors which can potentially lead to significant morbidity and mortality and also hinders study of the efficacy, optimisation and safety of VRIII. Thus, VRIII is often used when not indicated, for too long, and with inappropriate transfer to other glucose lowering medication. This article summarises the key recommendations in a recent guideline produced by the Joint British Diabetes Societies for Inpatient Care on the use of VRIII in ‘medical’ inpatients. The guideline is designed to be a practical guide to support the safe and effective use of VRIII by any healthcare professional who manages ‘medical’ inpatients with hyperglycaemia. Use of the guideline will help to harmonise the use of VRIII, with added benefits of facilitating collection of outcomes data from at multiple sites and allowing continual refinement in the therapeutic use of VRIII.