I work on med surg unit and had a pt with appx. 400 BS the other day. She was non compliant with her diet. Dr. gave me order to give 25 Reg inulin IV? I felt uncomfortable with this. Would you give 25u IV?
I am sure that he meant SQ not IV.... im pretty sure the rule for SQ is you can give up to 30 u of regular insulin SQ. So I would call to clarify the order and route.
but actually I work on Med-surg where they do hang Insulin drips... so yes it does happen.
but, but, but, 25 u IV is kinda high unless the patient weighs 550 lbs....
initial treatment for DKA is a IV bolus dose of 0.1u /kg followed by a drip of 0.1u/kg/hr
a 220 lb person would get a bolus of 10 u... and then followed by 10 u/hr drip
also with HHNS the glucose can be much higher than with DKA... even then the initial insulin dose is no more than 10 u/hr
Oh I just noticed that you said the patients glucose was 400... thats not DKA yet... DKA usually begins around 600 or 700 and HHNS usually begins around 800 or 900
So, for a glucose of 400... 25 units of SQ insulin (not IV) is probably acceptable... but I would start by giving only 10 at a time... and recheck in an hour... if still high give another 10 and recheck in an hour... then call the doc and get an order for a BMP lab.
Last edit by Nrs_angie on Nov 18, '07
How insulin resistant is the patient- how much do they take daily?
How high is the blood sugar?
Just in a very general sense, if the sugar is 800 or higher I might, but I would talk to the doc about electrolyte changes we would need to be monitering for. Otherwise I would tell the doc I'll give it in 15 and 10, 30 minutes apart, or they can do it themselves.
Someone that knows more than I do- what are the risks re electrolytes when someone has a high sugar and we bring them down very quickly? I know kids are at risk for cerebral edema because of the Na serum change, but a doc told me that is not the case with adults. Anyone know?
Last edit by canoehead on Nov 19, '07
: Reason: add a question