Variable Rate Intravenous Insulin Infusion

The Variable Rate Intravenous Insulin Infusion (VRIII) guideline (now replacing the previous 'insulin sliding scale' guideline) should be used in:

• Medical patients with diabetes who have uncontrolled hyperglycaemia or who are unable to eat and drink due to prolonged fasting, nausea, vomiting or reduced consciousness.
• Can be used in surgical patients with diabetes undergoing operations e.g. fasting >24 hours, emergency surgery or poor glycaemic control.

These guidelines should not be used in patients with:

• Diabetic ketoacidosis
• Hyperglycaemic hyperosmolar state / hyperosmolar non-ketotic coma
• Pregnant patients requiring intravenous insulin - refer to separate guidance under Maternity guidelines on AthenA