RBS 20.1. i want to start insulin in drip of Hartsol saline 1 L. How many units of insulin should be used
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insulin drip in saline 1 litre how many units blood sugar 20 mmol hyperglycemia protocol
Here is a clear, practical answer for your situation:
Insulin in IV Drip for RBS 20.1 mmol/L
What does "RBS 20.1" mean?
- 20.1 mmol/L = ~362 mg/dL - significantly elevated blood sugar.
How Many Units in 1 L Hartmann's / Normal Saline?
There is no single universal number - the units added depend on the protocol type you are using. Here are the standard approaches:
Option 1: Simple Bedside Rule (Common in South Asia / resource-limited settings)
Add units = blood glucose in mmol/L
- RBS is 20.1 mmol/L → add 20 units of Regular (soluble) insulin in 1 L NS or Hartmann's
- Run at 100 mL/hr → delivers ~2 units/hr
- This is a rough, widely-used ward-level approach
Option 2: Yale / Standard ICU Protocol (50 units in 500 mL = 1 unit/mL)
- Mix 50 units Regular insulin in 500 mL NS (or scale to 100 units in 1 L)
- Initial rate calculated as: Rate (units/hr) = (Blood glucose in mg/dL - 60) × 0.02
- For RBS 362 mg/dL: (362 - 60) × 0.02 = ~6 units/hr
- Flush 30 mL of tubing before starting (insulin adsorbs to plastic)
Option 3: GIK (Glucose-Insulin-Potassium) - if patient is fasting
- 10-15 units Regular insulin in 500 mL 5% Dextrose + 10 mEq KCl
- Run at 100 mL/hr
- Adjust insulin concentration based on hourly glucose checks
Key Points
| Parameter | Recommendation |
|---|---|
| Insulin type | Regular (soluble) insulin ONLY - never use long-acting IV |
| Concentration (ICU) | 1 unit/mL (50 units in 50 mL via syringe pump) or 1 unit/mL in 1 L bag |
| Monitoring | Check RBS every hour |
| Watch for | Hypokalemia (insulin drives K+ into cells) - check and supplement K+ |
| Hartmann's note | Hartmann's/Ringer's Lactate is preferred over NS to avoid hyperchloremic acidosis |
Bottom Line for Your Patient (RBS 20.1 mmol/L)
If using the simple 1 L drip method at ward level:
- Add 20 units of Regular insulin in 1 L Hartmann's saline
- Run at 100 mL/hr (delivers 2 units/hr)
- Recheck RBS in 1 hour; titrate accordingly
If this is a DKA/HHS patient in ICU, use the weight-based protocol: 0.1 unit/kg/hr via dedicated insulin infusion, preferably through a syringe pump at 1 unit/mL concentration - not in a large IV bag.
Important: Always check and correct potassium before or alongside insulin infusion. Do not start insulin if K+ < 3.5 mEq/L without replacement first.
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