How much insulin is too much?

Nurses General Nursing

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I have this patient : female, obese with an infection

problem is no matter how much insulin you inject her glycemia is always almost the same

4mg/dl~

at admission the insulin was working with 30 units it goes to normal ...but not anymore..

started giving her IV insulin and still no result makes you wonder if injected it at all :/

the Doctor is not helping ..

is this normal with an infection ? I haven't encountered a patient this irresponsible to insulin before

I'm guessing she got around 150 units of rapid insulin in 10 hours with no change in her blood sugar and she's been like that for days ...

yeah I can change the type

and I did that ...she responded much better but not enough ^^ thank you all

I had a resident who took 75 units of HUMALOG with each meal. Very first time I gave him insulin I looked at the MAR, went to my preceptor and said "this can't be right. I don't feel safe giving this amount of insulin." She replied "oh yeah. That's how much he takes. He'll be fine." So I gave it and sure enough his fsbs at hs was still in the 200's so I administered his 100 units of Lantus and 75 units of Levemir. It's very subjective like other posters have already commented "is it IV insulin? Do his maintenance fluids have D5? If he's on antibiotics, are they mixed with D5? Is he on solumedrol or prednisone? And what is his level of insulin resistance?"

yes on antibiotics mixed with saline generally

no steroids

IV and subcutaneous

around 160 units daily which is a lot

thank you now I understand that depending on the person the doses can go higher than 50 units which I was used to..

yes on antibiotics mixed with saline generally

no steroids

IV and subcutaneous

around 160 units daily which is a lot

thank you now I understand that depending on the person the doses can go higher than 50 units which I was used to..

Yes some people just have a super high resistance due to poor eating habits for 70+ years.

An infection does cause blood sugar to go up in diabetics and the fact her body is not responding to the change in the insulin regimen could be a lot of things. Resistance could be developing already and the routine she was on did have an effect. That is a huge amount to be giving, but some people have resistance and her lifestyle is another thing that we cannot control either. I had a non compliant patient once and she ordered everything you could think of.... the delivery man brought the food up to the floor. She was on precautions and you had to wear a gown gloves, and a mask. She had her lower extremities amputated and because of not complying with lowering her blood sugar... she was going to have another amputation. I don't remember how much insulin I gave her along with the IV antibiotics, but it was quite a lot and it didn't do much for her. It was really sad because it could have been prevented.

Specializes in orthopedic/trauma, Informatics, diabetes.

This is why they make U-500 insulin.

On the insulin gtt issue, pts must have mealtime insulin or you just keep using the gtt as coverage. It is supposed to act as an adjustable basal

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