Insulin Syringe Research Articles

Культура генетически трансформированных корней (hairy roots) Silene roemeri Friv. – источник получения фитоэкдистероидов

The hairy roots culture attracts increasing attention of researchers as the system of obtaining valuable secondary metabolites. Investigation of the features of biosynthesis of ecdysteroids by this biotechnological system and evaluation of the parameters of its productivity are important problems in the studies of the directed biosynthesis of secondary metabolites of plants and selection of the lines that are superproducers of biologically active substances. The aim of the research was to obtain hairy roots Silene roemeri culture and study the content of phytoecdysteroids in this culture. We obtained hairy roots culture of ecdysteroid-containing species S. roemeri by means of Agrobacterium-mediated transformation (strain A4 RT). The transformation was carried out according to the following scheme: sterile seedlings were divided into cotyledons, hypocotyls, and roots, pricked with a needle of an insulin syringe and inoculated for 24 hours in the liquid nutrient medium MS containing a suspension of a day-old A. rhizogenes agrobacterium. After exposure, the inoculates were washed with the sterile V MS medium and placed, for the development of the transformation, in the agar-containing V MS medium with antibiotic added (500 mg l -1 cefotaxime). Two weeks later, after the appearance of root rosettes, they were separated and relocated in the same nutrient medium with cefotaxime. We cultivated hairy roots in Gamborg's В 5 medium with an addition of 500 mg l -1 casein hydrolyzate. The growth index was 8.3-9.6. We carried out biochemical analysis of thus obtained culture for the concentrations of ecdysteroids by means of high-performance liquid chromatography. We discovered a number of nonpolar and medium-polar ecdysteroids. We established that cultivation is accompanied by the biosynthesis of over 20 ecdysteroids, including integristerone A, 20-hydroxyecdysone, 2-deoxy-20-hydroxyecdysone, and 2-deoxyecdysone. Estimation of the levels of the major ecdysteroid 20-hydroxyecdysone showed that its content was 0.1%. It allows considering hairy roots S. roemeri as a culture with a high biosynthetic activity. Our results show that the use of the hairy roots cultures of S. roemeri are a potential source of phytoecdysteroids and a promising system to study biosynthesis routes, localization of phytoecdysteroids, and methods to improve their products.

Reversed-phase single drop microextraction followed by high-performance liquid chromatography with fluorescence detection for the quantification of synthetic phenolic antioxidants in edible oil samples.

The reversed-phase mode of single drop microextraction has been used as a preparation method for the extraction of some phenolic antioxidants from edible oil samples. Butylated hydroxyl anisole, tert-butylhydroquinone and butylated hydroxytoluene were employed as target compounds for this study. High-performance liquid chromatography followed by fluorescence detection was applied for final determination of target compounds. The most interesting feature of this study is the application of a disposable insulin syringe with some modification for microextraction procedure that efficiently improved the volume and stability of the solvent microdrop. Different parameters such as the type and volume of solvent, sample stirring rate, extraction temperature, and time were investigated and optimized. Analytical performances of the method were evaluated under optimized conditions. Under the optimal conditions, relative standard deviations were between 4.4 and 10.2%. Linear dynamic ranges were 20-10000 to 2-1000μg/g (depending on the analytes). Detection limits were 5-670ng/g. Finally, the proposed method was successfully used for quantification of the antioxidants in some edible oil samples prepared from market. Relative recoveries were achieved from 88 to 111%. The proposed method had a simplicity of operation, low cost, and successful application for real samples.

Challenges with Insulin Use Among Patients with Type 2 Diabetes Mellitus: Focus on a Tertiary Healthcare Setting in South-East Nigeria.

Effective usage of insulin in the management of diabetes remains a challenge in developing countries like Nigeria. The objective of this study is to document the pattern of insulin prescription, frequency, storage, common regimen used, and attendant problems associated with its use in patients with type 2 diabetes mellitus (T2DM). This was a prospective, descriptive study in which consecutive T2DM patients seen at the medical out-patient clinic and medical wards and who fulfilled the criteria for inclusion were recruited. Participants provided information on their demographic characteristics, diabetes history, treatment and problems associated with treatment, type of insulin in use, number of daily injections, storage, method of insulin administration and problems associated with insulin use. Clinical examination was carried out basically to determine the anthropometric indices. About 84.3% have used insulin for less than 5 years. The thigh was the commonest site of insulin administration (95.3%). About 94.3% of subjects in this study store their insulin in a refrigerator. And Insulin dosing regimen ranged from less than once to four times daily while majority of patients (63%) were on twice daily insulin regimen. Insulin administration devices used were Insulin syringes 394 (98.5%) and Insulin pens 6 (1.5%). Thirty three percent of the subjects self inject insulin while about half of the study subjects (50.5%) receive insulin from a healthcare provider. The most common insulin used by patients was Mixed/ Premixed insulin (32.8%) and Regular/ Soluble insulin (38.8%). Hypoglycaemia was the most frequently documented problem encountered by subjects on insulin followed by weight gain. Majority of the study subjects (50.8%) practice self monitoring of blood glucose (SMBG). This study has demonstrated that majority of subjects with T2DM were on premixed insulin and that hypoglycaemia is the most common problem reported by patients. Insulin pens were not common among our study population.

Insulin delivery: what is new in the queue?

Diabetes Mellitus (DM) is a cluster of metabolic disorders with the shared feature of hyperglycemia which may be due to discrete etiopathogenesis. India stands to be the diabetic capital of the world, second only to China. After its discovery by Banting and Best, it has been established that insulin plays a fundamental role in the management of DM. In spite of insulin being in the market for so long, what still remains a challenge is the invasive approach of its administration. Conventional pharmacotherapeutic approaches of insulin delivery that have been available over the years are insulin syringes, pumps and pens. Upcoming innovative modes of insulin delivery include oral insulin, inhaled insulin, colonic insulin delivery, transdermal insulin, intra-peritoneal insulin, intra-nasal insulin, nano-technology etc. Constant research has been going on since many years to discover a route of administration for insulin that is minimally or noninvasive, effective, safe, convenient and cost-effective for patients. If successful, alternative routes of administration could revolutionize the treatment of DM and help improve patients’ quality of life.

Insulin Syringe: A Gimmick in Pediatric Dentistry.

AimThe management of pain and anxiety in dentistry encompasses a number of procedural issues, including the delivery of anesthetic solution. One of the most important ways to manage the behavior of children is pain control. Trypanophobia is very common among dental patients and the most important goal of guidelines on behavior guidance for pediatric dental patient is to ease fear and anxiety in dental procedures in children. For the stated reasons, the purpose of the present study was to record child’s pain sensation both objectively and subjectively while receiving dental local anesthesia using conventional syringes and diabetic needles.Materials and methodsTwenty children of age group 6 to 12 years undergoing routine dental procedures participated in the study. Every child acted as one’s own control, while receiving treatment on the opposite side of the same arch. Each patient was randomly assigned to receive the injection either with conventional syringe or diabetic needle for the first visit, while the injection with the other needle was administered during the second visit. Rating scales were used for objective and subjective evaluations.ResultsStatistical analysis of the measurements were made using Wilcoxon signed U test and Mann-Whitney U test which showed the mean sound, eye, motor (SEM) score difference using insulin syringe. The outcome was statistically significant when compared using the mean ranks between male and female patients with that of control group.ConclusionIt can be concluded that diabetic syringes exhibit clinical advantage and its use in pediatric dentistry for local anesthetics (LA) infiltration can prove beneficial.How to cite this article: Kour G, Masih U, Singh C, Srivastava M, Yadav P, Kushwah J. Insulin Syringe: A Gimmick in Pediatric Dentistry. Int J Clin Pediatr Dent 2017;10(4):319-323.

An Audit of Insulin Usage and Insulin Injection Practices in a Large Indian Cohort.

Introduction:Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM.Methodology:A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006–2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices.Results:Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%).Conclusion:The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India.

Awareness of home drug storage and utilization habits: Saudi study

The aim of the study was to investigate the awareness of residents in Saudi Arabia toward in-home drug storage and the using habits of their medications. This is a descriptive study that involved an electronic survey about drug storage and utilization habits. It was developed, pretested, and distributed via the social media among the population in Saudi-Arabia. About 1400 persons participated in this study. Around 84.4%, 96.6% and 58.3% of participants stored their insulin syringes, antibiotic or cough-syrup after opening in there frigerator, respectively. Moreover, most of them avoided use or discard their products upon exposure to the sun or forgetting them in the car for the whole day. 87.5% disclosed that they usually check the expiration date on drug products before using and 49.7% added they always follow the instructions regarding duration-of-use compared with 45.85% who said sometimes they follow it. 99.7% of them reported that they avoid using products upon change in color or formulation. Finally, variable-correlation was found between the age distribution of participants and their responses. The results revealed that the participants exhibited promising awareness toward the in-home drug storage in Saudi Arabia

Effect of Sperm Sac (Testis) in Cryopreservation Protocol of Milt (Spermatozoa) of &lt;i&gt;Clarias Gariepinus&lt;/i&gt;

This study was carried out to assess the adequacy of cryopreservation protocol of milt (spermatozoa) of Clarias garipenus , using the sperm sac (testis) intact with the objectives of evaluating the milt for percentage live, motility and mass activity for a period of seven days at -20°C. Semen samples (milt) were collected from mature male broodstocks of Clarias gariepinus of 14 months old and weighing 1.5 kg. There were two groups comprising test and control groups. Test group comprising of the sperm sac was dipped in Na-Citrate and placed in a properly labelled container and preserved at -20°C while control group comprised of milt extended in Na-Citrate dispensed into seven insulin syringes, properly labelled and stored at 4°C. These were observed for a period of seven days and percentage motility, percentage live as well as mass activity of spermatozoa of these samples were recorded. Student’s t test was used in analyzing the data. Results showed statistically significant difference (p<0.05) in motility, percentage live and mass activity between test and control groups, with test group showing mean percentage motility, percentage live and mass activity of 24.29±76%, 24.29±76% and 1.14±1.8 respectively while the control showed values of 48.57±65%, 48.57± 65% and 2.0±1.0 respectively. It was concluded that use of the sperm sac at -20°C can only be adopted within three days of collection from the fish. It was recommended that farmers adopt the protocol only for a short term period to eliminate the frustration of artificial spawning failure due lack of good semen to complete the synchronous reproductive process.

Practical use of insulin in diabetes mellitus

Insulin therapy is the cornerstone of treatment in patients with type 1 diabetes mellitus (DM) and advanced type 2 DM. Over the years, insulin treatment has advanced from animal insulin to recombinant insulin with more efficiency and fewer side effects and from short-acting conventional insulin to ultrashort and long-acting insulin analogs to mimic various phases of physiological insulin secretion. Various insulin delivery systems from conventional subcutaneous insulin injection using insulin syringe to pen device, subcutaneous insulin infusion pumps, and inhaled insulin to artificial pancreas are now available. Proper insulin injecting techniques and patient education on self-monitoring of blood glucose and insulin dose titration are of utmost importance for effective insulin therapy.

Evaluation of apically extruded debris and irrigant using different file systems.

The aim of this study was to evaluate the amount of apically extruded debris and irrigant during cleaning and shaping with different file systems. Seventy-five extracted mandibular premolar and canine teeth were randomly divided into five groups (n = 15). The root canals were instrumented by using Mtwo (VDW, Munich, Germany), Twisted File (TF; Sybron Endo, Orange, California, USA), Reciproc (VDW), Self-Adjusting File (SAF; Re Dent-Nova, Ra'anana, Israel) systems, and K-type stainless steel hand file (Mani Inc., Tochigi, Japan). Apically extruded debris was collected and dried in preweighed Eppendorf tubes. Extruded irrigant was collected from the cannula by using a plastic insulin syringe. After drying, the amount of apically extruded debris was established by subtracting the initial weight from the final weight of the tubes. After performing the Kolmogorov-Smirnov test, data were analyzed by Kruskall-Wallis test at a significance level of P value less than 0.05. There were no statistically significant differences between the file systems in terms of debris and irrigant extrusion. Mtwo group produced the highest mean debris extrusion value and the TF group produced the less compared with the other files. The least mean irrigant extrusion value was associated with the SAF group, whereas the highest mean irrigant extrusion value was associated with the Reciproc group. Under the conditions of the study, all file systems were associated with apical debris and irrigant extrusion.

Possibilities of preparation and storage of standard histamine solutions

Background. To explore the stability of histamine solutions of low concentrations sterilized by autoclaving and filtration as well as the possibilities of storage and use of these solutions after 1-fold and 5-fold freezing and defrosting. Methods. Histamine dihydrochloride solutions at a concentration of 10 μg/ml were sterilized by the membrane filtration or the autoclaving at 121 °C for 30 minutes. The solutions were frozen in sterile insulin syringes, followed by 1- and 5-fold defrosting. Skin prick tests have been performed with the resulting solutions. Results. When comparing the results of skin prick testing performed with autoclaved and sterilized by the filtration histamine, no statistically significant differences were found (p&gt;0,05). Comparison of the results of skin prick tests performed with histamine that hadn't been frozen before, after 1- and 5-fold freezing and defrosting showed no statistically significant differences (p&gt;0,05). Conclusion. It has been shown that histamine solutions sterilized by autoclaving at 121 °C for 30 minutes followed by repeated freezing and defrosting don’t change their biological activity substantially.

PMD20 - Status and Expenses: Re-Use Of Insulin Syringe Needles in the Diabetic Patients in Beijing

PMD20 - Status and Expenses: Re-Use Of Insulin Syringe Needles in the Diabetic Patients in Beijing

Single suture customized loop for large iridodialysis repair.

Managing large iridodialysis that may occur during phacoemulsification is challenging. I describe how a procedure to reposit a prolapsed iris while the anterior chamber is markedly inflated by a current of infusion fluid may inadvertently lead to large iridodialysis, and discuss how to avoid such a complication. I describe a fast and efficient technique for managing large iridodialysis both immediately, once it occurs, or as a secondary maneuver. My technique involved fixing the iris periphery back to its root at the anterior chamber angle using 10-0 polypropylene suture with two straight needles introduced directly through the cornea at distant points, and an insulin syringe as a guide track to a point 1.5 mm from the limbus at the base of a triangular scleral flap that was designed to be centered on the area of iridodialysis. I confirmed the simplicity, efficacy, and safety of my technique through a 1-year follow-up period.

Commentary: Why Was Inhaled Insulin a Failure in the Market?

Just a few years shy of a century ago, a group of Canadian researchers discovered a viable method of extracting insulin, filling a large and critical gap in the therapeutic treatment of diabetes (1). Since then, insulin and its associated delivery devices have become an integral part of the care and management of patients living with diabetes. Shortly after the first insulin injection was successfully delivered, vials of insulin became available commercially. At this time, large glass syringes were used to administer insulin, and each injection required sterilization of the syringe, as well as sharpening of the syringe needle with a pumice stone. Through the years, insulin syringes modernized, but it was not until the 1970s that an alternate delivery system—the insulin pump, used in continuous subcutaneous insulin infusion (CSII) regimens—became available. Fifteen years later, the first insulin pen was introduced to the marketplace, providing evidence that, as time progresses, there is no shortage of innovation in the diabetes arena. The first two rapid-acting inhaled insulins on the market—Exubera in 2006 and Afrezza in 2014—represented yet another innovation milestone. In theory, inhaled insulin completely eliminated the psychological barriers associated with subcutaneous insulin delivery, such as needle phobia and incorrect injection technique. However, in October 2007, Pfizer withdrew Exubera from the market, and in January 2016, Sanofi withdrew from a $925 million marketing agreement with MannKind for Afrezza; both removals were due to poor sales volume. Although patients and providers have been searching for years for alternatives to injecting insulin, Exubera has already failed, and Afrezza’s destiny is uncertain. In 2006, Exubera was the first inhaled insulin approved by the U.S. Food and Drug Administration (FDA). It showed noninferiority in efficacy with regard to A1C lowering in both type 1 diabetes (2) and type 2 diabetes (3) compared to mixed regular/NPH …

INSULIN TREATED PATIENTS

Objective: To determine the trends in insulin injection technique and associatedcomplications in the local diabetic patients. Study Design: Cross-Sectional Descriptive study.Place and Duration of Study: This study was conducted in Department of Medicine at FatimaMemorial College &amp; Hospital Lahore from 25th May 2015 to 25th October 2015. Patientsand Method: Three hundred patients above 18 years of age who presented in outdoor andindoor department of the hospital, gave consent were enrolled. The data was collected throughinterview and relevant physical examination; data was analyzed by using SPSS 20.0 version.Results: 300 diabetics were enrolled; 108 (36%) male and 192 (64%) female. Mean age inmales was 52.8±13.7 and in females was 52.2±11.8. Duration of insulin use was less than5 years in 175 (58%) and 5 years or more in 125 (42%). Insulin syringe of 8 mm gauge wasbeing used by 263 (87%). Abdomen was the injection site in 202 (67%); however, 279 (93%)rotated the injection site. The angle of injection was kept at 90 degrees by 254 (85%). Theneedle was reused for five or more times by 187 (52%) and 216 (72%) were self-injecting. Localcomplications were seen in 105 (35%); out of those pain was most commonly (35 %) reported.Among age groups significant association (p&lt;0.05) was seen in site of insulin delivery, in agemore than 60 years more injected in abdomen. In gender groups more males (83%) wereself-injecting. Significant association (p&lt;0.05) was seen in duration of insulin use and localcomplications. Majority, 126(72%) of those who were on insulin for less than 5 years did nothave complications. Conclusion: Majority of our patients had adopted reasonable techniquehowever repeated reinforcement can further improve appropriate insulin delivery, less wastageof insulin and better glycemic control with less chance of complications.

English

Objective: To determine the trends in insulin injection technique and associated complications in the local diabetic patients. Study Design: Cross-Sectional Descriptive study. Place and Duration of Study: This study was conducted in Department of Medicine at Fatima Memorial College & Hospital Lahore from 25th May 2015 to 25th October 2015. Patients and Method: Three hundred patients above 18 years of age who presented in outdoor and indoor department of the hospital, gave consent were enrolled. The data was collected through interview and relevant physical examination; data was analyzed by using SPSS 20.0 version. Results: 300 diabetics were enrolled; 108 (36%) male and 192 (64%) female. Mean age in males was 52.8±13.7 and in females was 52.2±11.8. Duration of insulin use was less than 5 years in 175 (58%) and 5 years or more in 125 (42%). Insulin syringe of 8 mm gauge was being used by 263 (87%). Abdomen was the injection site in 202 (67%); however, 279 (93%) rotated the injection site. The angle of injection was kept at 90 degrees by 254 (85%). The needle was reused for five or more times by 187 (52%) and 216 (72%) were self-injecting. Local complications were seen in 105 (35%); out of those pain was most commonly (35 %) reported. Among age groups significant association (p<0.05) was seen in site of insulin delivery, in age more than 60 years more injected in abdomen. In gender groups more males (83%) were self-injecting. Significant association (p<0.05) was seen in duration of insulin use and local complications. Majority, 126(72%) of those who were on insulin for less than 5 years did not have complications. Conclusion: Majority of our patients had adopted reasonable technique however repeated reinforcement can further improve appropriate insulin delivery, less wastage of insulin and better glycemic control with less chance of complications.

Effectiveness of nursing intervention regarding self insulin administration among diabetic patients

Objective: the study was carried out to assess effectiveness of nursing intervention regarding self insulin administration among diabetic patients. Methods: Research design: A quazi experimental design was utilized. Setting: Medical Clinic at Health Insurance Hospital, at Shebein El-Kom, Menofia Governorate, Egypt. Subjects: Convenient sample of 200 diabetic patients who were self insulin administered. Tools for data collection: Interviewing questionnaire includes socio demographic date, knowledge questionnaire sheet regarding self-administration of insulin, and observational checklist. Results: Majority of studied sample was married female that have negative family history of diabetes, and are insulin injected for more than 1 year. Majority of studied sample have poor knowledge and incorrect practice their barriers to continuing insulin were pain, too expensive, and weight gain, the main points that improved by nursing intervention were as follows: air bubbles removing before injecting using the insulin syringe, frequently change site of injections, before injection keep insulin vial at room temperature at least for 15 minutes, and disposal of used needles in a safety box at home, the only statistical difference between knowledge and practice was after one week of intervention among study group. Conclusions: The study concluded that the knowledge regarding insulin injection and self-administration of insulin practice after the nursing intervention were increased which is related to the effectiveness of the nursing intervention.

Assuring epidemiological safety for healthcare of patients with diabetes mellitus

Healthcare associated infections (HAI) — infections that patients develop during the course of receiving healthcare in hospitals, outpatient department and at home, out of healthcare facilities, and infection resulting from occupational exposure. Patients with diabetes are vulnerable to HAI. Infections increase metabolism problems in patients with diabetes; and vice versa, high blood glucose level increases risk of infections. For assuring epidemiological safety for patients with diabetes infection control must be provided for the following medical practices: insulin injections; blood glucose test; care of diabetes foot; intravascular catheterization and surgery. Any invasive procedures increase the HAI risk. HAI are most commonly transferred through direct and indirect contact with the infection. Some of the main HIA preventive practices: staff cleaning hands with alcohol based sanitizer, single use of medical gloves, single use of insulin needles and syringes. In health facilities only multiple users and multiple blood glucose monitoring devices must be used by health providers. The protocol of glucose blood testing should include detailed disinfection procedures and additional measures to decrease the risk of potentially transmitting disease between patients and between patients and providers. Health providers should have special skills to care of patients with diabetes foot to perform non-traumatic procedures and infections control practices. Proper hand hygiene and gloves use combined with effective aseptic technique before catheter insertion and maintenance protect against severe HAI. Risk of infections significantly decreases when single-dose antibiotic was used before surgery as antimicrobial prophylaxis. To disease risk of infections patients should be recommended to strictly control diabetes during the weeks before elective surgical procedures.

Pre-filling of insulin syringes

Careful procedures must be in place to protect both patient and nurse, explains Samantha Rosindale

Development of a cross-disciplinary continuous insulin infusion protocol for non-critically ill patients in a French university hospital.

In non-critically ill patients, the use of an insulin syringe pump allows the management of temporary situations during which other therapies cannot be used (failure of subcutaneous injections, awaiting advice from the diabetes team, emergency situations, prolonged corticosteroid therapy, initiation of an artificial nutrition, need for a fasting status, etc.). To manage the risks related to this «never event», the use of a standard validated protocol for insulin administration and monitoring is an essential prerequisite. To this end, a multidisciplinary approach is recommended. With the support of our subcommission «Endocrinology-Diabetology», we proceeded with a «step-by-step process» to create such a standardized protocol: (1) review of all existing protocols in our hospital; (2) overview of the literature data concerning insulin infusion protocols developed by multidisciplinary teams in France and abroad; (3) development of a standardized protocol for non-intensive care unit patients, respecting the current recommendations and adapting it to the working habits of health teams; and (4) validation of the protocol Two protocols based on the same structure but adapted to the health status of the patient have been developed. The protocols are divided in to three parts: (1) golden rules to make the use of the protocol appropriate and safe; (2) the algorithm (a double entry table) corresponding to a dynamic adaptation of insulin doses, clearly defining the target and the 'at risk situations'; and (3) practical aspects of the protocol: preparation of the syringe, treatment initiation and traceability. The protocols have been validated by the institution. Our standardized insulin infusion protocol is simple, easy to implement, safe and is likely to be applicable in diverse care units. However, the efficiency, safety and the workability of our protocols have to be clinically evaluated.