Typically, insulin is delivered via the subcutaneous route to manage Type I and Type II Diabetes.

In certain circumstances, insulin can be delivered by the intravenous route. This approach normally takes place within the secondary care setting (i.e. the hospital) to manage conditions such as:

Ketoacidosis - When the body does not have sufficient insulin to allow blood sugar into cells to generate energy. Here, fatty tissue is broken down to provide the energy base with the related release of acids (or ketones) into the blood that can in turn be life threatening.
The hyperosmolar state - A serious complication of diabetes that occurs when blood sugar levels are extremely high for a prolonged period of time. This is also a medical emergency that requires emergency treatment.

The intravenous route is also of use for those diabetic patients who are due to have major surgery or ‘nil by mouth’ following surgery (i.e. it provides clinicians and the medical team with tight control).

The VRII is commonly referred to as a “sliding scale regimen”. This is so because the rate of insulin infusion is adjusted in relation to the blood sugar levels, which are usually monitored on an hourly basis.

Normally, a short acting insulin is used (i.e. a product with a short half-life). A good example of this is Actrapid and this is a soluble insulin product.

At the same time, a glucose infusion is prepared and administered alongside potassium (unless the patient is hyperkalaemic).

This type of infusion is not prescribed for those patients that are eating and drinking normally; this type of regimen is reserved for the secondary care setting.

For more information on the FRII vs VRII regimens, please contact our Lead Tutor Dr Davies via ‘Contact Us’.