How much insulin is too much? - page 2

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... Read More

  1. by   YUKONrn
    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?"
  2. by   liluiass
    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..
  3. by   YUKONrn
    Quote from liluiass
    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.
  4. by   Qing
    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.
  5. by   mmc51264
    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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