i have a question, i had a patient who is diabetic and at 6 am her bs was 282, the night nurse covered with reg. insulin 4 u and her normal 22 u 70/30 qam. at 9 am tech tell me that she concerned about pt. i go in, she is lethargic, diaphoretic and petite mal seizuring. i take her bs and its 30 i give her oral glucose and call charge rn. pt. trying to swollow tounge and cant get oral glucose in. well i am prn agency and this is a nursing home and they have no iv glucagon or sublingual clodadine (bp 180/110 hr 132). well we get im glucose and retake sugar 49. fd came and got a line and bolus glucagon went to 349, know shell burn that off by the time she gets to er. me and doc decide to have her go because of seizures and make sure no stroke defects present(usually follow after seizures) well get report form er that pt had a UTI. pt totally A&O x 3 and never c/o UTI or pt know what all meds are and their s/e. me and doc dont beleive er and had pt get s/c for ua/cs got labs back form er...wbc 25.000
and few bacteria present bun/creat slight elev. due to abnormal homeostasis...have you ever heard of UTi causing BS to drop so bad??? sorry so long...very concerned!!!
May 19, '04
The UTI will usually send the glucose up. she was covered with extra insulin, and sometimes that will be just enough to push them over and over-stimulate her pancreas. Is she a Type I or Type II diabetic.
Have seen it happen several times in the past. This patient had insulin at 6 am, did she not eat her breakfast? If she wasn't feeling well due to to the UTI, her calorie intake was probably down, and surprise..................
Had you observed her already in your shift? She may not have been feeling well to begin with and if insulin is given at 6am, night nurse may not have been aware of anything different.
One reason why I do not like insulin given at 6am, food isn't usually served until at least 7:30 and you do not know how the patient is going to eat. Plus regular insulin will peak before then.....................
Last edit by suzanne4 on May 20, '04