Why do we use insulin drips? - page 2

Hi everyone! I'm a new nurse working on a Post-Transplant/Surgical unit (kidneys and pancreases only). I'm curious about insulin gtts. A few weeks ago I had a patient on an insulin drip--hx: infected... Read More

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    I'm going to venture a novice guess here and suggest that it is simply because of rapidly changing conditions within the body and the fact that the patient is not taking food PO. A traditional insulin to carb ratio wouldn't work since carbs are processed differently via TPN than through the gut. Rapid acting insulin also will hopefully prevent any stacking from going on which can occur with different absorption rates SQ. Add to that, on a transplant unit the likely use of corticosteriods which messes up BG levels as well would make it easier to titrate dosing based on continuous glucose monitoring or frequent testing.

    I also think it would be easier to set a lantus dose once you can average the gtt rates to determine a basal rate. I guess I think of it as a reverse equation for setting up insulin pump basal rates considering the Total Daily Insulin amount.

    In terms of what insulin type to use, regular insulin is the only solution. The rest are suspensions. When administered IV, onset of action is about 15 mins with duration of action 30-60 mins, which I'd think makes it easier to calculate hourly rates. With that rapid of effect, it would seem unnecessary to use anything faster like the rapid-onsets.


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  2. 0
    I treat inpatient diabetes, almost exclusively for pts requiring IV insulin. We use it for pts in metabolic disarray...even those who are not diabetic! Those having major chest surgeries, pts having lesser surgeries but who have CBGs >150, etc., have better outcomes with less post-op infections when glucose is tightly managed.

    Then we manage how to safely bring them off the drip afterward, address any diabetes issues present prior to admit...such as being uncontrolled, need for new med regimen, etc. That's my life.
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    I work post surgical and get insulin gtt all the time. THE PRIMARY REASONS for the insulin post surgical and trauma is because Under stress conditions, the body releases cortisol (stress hormone) which affects blood glucose many ways causing it to increase.

    Now, these hyperglycemic states reduce healing time and also put a patient at a increased risk for infection. Remember that bacteria LOVE sugar.

    And the ONLY insulin that can be given IV is Regular!
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    I hope you can take a little bit of what everyone has said, because most have valid points. To answer your question about why the patient was on the drip would take a little more history that what you supplied, but obviously the infection, TPN, and the NPO status would all lead to a fluctuation in the patients blood sugar level. Like many people stated above tight control around or slightly above the normal limits decreases infection risks, which is a huge concern in the hospital setting (especially long-term). As to why not use oral meds...Is the pancreas functioning well enough to make any insulin at all? If not there goes the oral meds. And like others have said SC would not provide adequate control because it doesn't act as quickly as the IV and the FSBS checks would probably only be done Q4H.
    I guess I didn't really add anything, but maybe I summed it up a bit.

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