Quote from wyshywashy
So with that reasoning...D5W is too low to use with insulin right?
I hope my understanding is correct.
Yes, D5W is not enough dextrose to counteract the insulin. At my hospital, we usually give 10 units of regular insulin IV (not subcutaneous), "one amp" of D50 (which is actually a 50mL bottle that we draw up in a giant syringe), a stat albuterol breathing treatment, and sometimes an amp of bicarb (which is also not an ampule...it's either a Bristojet or a 50mL bottle).
I always check the blood sugar prior to adminstration...if it's already, say, 150 and the patient is a diabetic, chances are their blood sugar will be 180 30 to 45 minutes after administration. On the other hand, if their blood sugar is 85 pre-administration and they are NOT a diabetic, their blood sugar might be (and has been!) 46 after 30 to 45 minutes. In which case, per our policy, they get another amp of D50. If they're a renal failure patient, their blood sugar could be 300 before administration and then 32 after administration (yep, it's happened...without the kidneys clearing the insulin from the system, it just keeps hanging around).
The tonicity of D50 probably has very little effect...it turns into 50mL of sterile water pretty quickly in the body. However, if a patient is acidotic (which can lead to hyperkalemia), it is possible that they are septic or in DKA. Fluid replacement *is* an important part of treatment if that's the case, though I usually see isotonic solutions.