Need help understanding an insulin drip
- 0Mar 18, '11 by KD CVICU-RNCan anyone explain WHY we give D10W with an insulin drip? I am trying to understand the relationship and the pathophysiology of this. Thanks!
- 0Mar 19, '11 by KD CVICU-RNNo, just standard Endotool for a post-op pt. that isn't NPO. I understand that they need some form of sugar, but if we are trying to keep tight parameters on their blood glucose post-op, why would we give dextrose on top of the insulin? The orders read, continue D10W @ 30mL/hr if BG < 180 and continue Endotool. Thanks!
- 0Mar 30, '11 by BiffbradfordWell, everybody's Insulin protocol is different, and every surgeon has their own preferences. If the patient was a fresh post-op, then perhaps they just wanted to make sure they didn't bottom out from the drip. Look closely at the patient's history, that might give you some clues.
- 1May 1, '11 by akulahawkRN, ASN, RN, EMT-PI'm not an RN, nor am I familiar with the Endotool... but I think I've got a handle on this.
A quick review of this topic and my own knowledge of insulin/glucose leads me to exactly the same conclusion - it's precisely to keep the patient from going hypoglycemic. As the Endotool is a computerized insulin therapy system that adapts to a patient's blood glucose levels, it isn't able to instantly stop insulin that's already in the body from continuing to work if glucose levels suddenly drop off and there's no glucose source available to bring the level back up. I imagine that the system is certainly capable of controlling insulin infusion rates, so there's either a steady-state D5 or D10 infusion going OR the system can control both infusion rates.
To me, it makes sense to control both the insulin and a source of glucose. You use the insulin to keep the glucose level from going too high and the glucose in the IV fluid to keep the level from going too low. Ideally, you'll eventually end up with a very tight control over blood glucose levels because you're basically controlling BOTH sides of the problem. If the patient is not NPO and consumes some amount of carbohydrate, in the short term, you'd see that glucose level spike and the Endotool will adjust by providing more insulin and as glucose levels drop off, so will the rate of insulin infusion, but circulating insulin will still be doing "it's thing" while the D10 provides a backstop against hypoglycemia.
I'm just a well-educated pre-nursing student.
- 1May 16, '11 by ckh23If you have IV insulin infusing you need to have some type of dextrose going IV, whether it is D10, D5 1/2, TPN, etc. The reason is to prevent hypoglycemia. The effect of IV insulin is very quick and without some type of dextrose your patient can go hypoglycemic quickly. Even if the patient is eating regularly, what happens to the BS when they are not? They go hypoglycemic.
- 0May 26, '11 by NAURNWe use endotool as well, and some of the drs choose not to use the d10... actually the majority of them. For DKA, you need to feed the body insulin to correct the problem, so there is a reason for dextrose in those patients, but your run of the mill hyperglycemics that are put on insulin drips, we don't use the d10