Piggyback infusion in Diabetes
Insulin and glucose are given by infusions in a “piggyback” fashion means attaching one infusion line to another and further it continues as one line.This allows independent regulation of insulin and glucose infusion rates while maintaining a single entry portal.Glucose can be given as a 5%,10% or 20% solution.Insulin can be given at a rate of 0.5-10 units/hr.Adjustments can be done as necessary.The goal is to maintain plasma glucose levels in normal range.
This method is preferred over GIK infusion approach especially in extensive surgeries.
As in cardiac surgery the insulin requirement varies according to various stages of surgery like skin incision,on CPB,coming off CPB and postoperatively due to varied hyperglycemic response.
Before attaching this piggyback line to the dextrose infusion, flush the line with infusion mixture and discard the flushing solution.This approach saturates insulin binding sites on the tubing.
The infusion rate formula is : Insulin (U/hr)= serum glucose(mg/dl)/150