Appendix 5 Table 1.

Appropriate action depending on blood glucose level

Test	Blood glucose result (mg/dl)	Action
A: Measure blood glucose on entry to ICU	>220	Start insulin at a dose of 2–4 IU/h. Continue as per test B
	220–110	Start insulin at a dose of 1–2 IU/h. Continue as per test B
	<110	Do not start insulin but continue blood glucose monitoring every 4 h. Continue as per test A
B: Measure glucose every 1–2 h until in normal range	>140	Increase insulin dose by 1–2 IU/h
	110–140	Increase insulin dose by 0.5–1 IU/h
	Approaching normal range	Adjust insulin dose by 0.1–0.5 IU/h. Continue as per test C
C: Measure glucose every 4 h	Approaching normal range	Adjust insulin dose by 0.1–0.5 IU/h
	Normal	Leave insulin dose unchanged
	Falling steeply	Reduce insulin dose by half and check every 1–2 h
	60–80	Reduce insulin dose and check blood glucose within 1 h
	40–60	Stop insulin infusion, assure adequate baseline glucose intake and check blood glucose within 1 h
	<40	Stop insulin infusion, assure adequate baseline glucose intake, administer glucose per 10 g IV boluses and check blood glucose within 1 h