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

Stella George, Jane Dale, Debbie Stanisstreet, On Behalf of the Joint British Societies for Inpatient Care, and the Joint British Diabetes Societies Medical VRIII Writing Group


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.

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Health and Social Care Information Centre. National Diabetes Inpatient Audit (NaDIA) – 2012. Available at http://www.hscic.gov.uk/catalogue/PUB10506 (accessed March 2015).

Joint British Diabetes Societies for Inpatient Care. The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients. October 2014. Available at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_ VRIII. pdf (accessed March 2015).

Virtual College. The Safe Use of Intravenous Insulin Infusion in Adults. Available at http://www.healthcareea.co.uk/the_safe_use_of_intravenous_insulin_infusion_in_adults (accessed March 2015)

Savage MW, Dhatariya KK, Kilvert A, et al, for the Joint British Diabetes Societies. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011;28:508-15. http://dx.doi.org/10.1111/j.1464-5491.2011.03246.x

Joint British Diabetes Societies Inpatient Care Group. The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. Available at www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_HHS_Adults. pdf (accessed March 2015).

Joint British Diabetes Societies (JBDS) for inpatient care. Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes. Available at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Enteral_Feeding_Stroke.pdf (accessed March 2015).

Joint British Diabetes Societies. Management of adults with diabetes undergoing surgery and elective procedures: improving standards. April 2011. Available at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_ IP_Surgery_Adults_Full.pdf (accessed March 2015).

NHS Diabetes/Joint British Diabetes Societies. The hospital management of hypoglycaemia in adults with diabetes mellitus. Available at www. diabetologists-abcd.org.uk/JBDS/JBDS_IP_Hypo_Adults.pdf (accessed March 2015).

DOI: https://doi.org/10.15277/bjdvd.2015.014


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