Hyperglycemia

It's usually given IV pretty quick out here in the sticks.

Our docs send people home in the 300's if they have no ketones.

Our docs send people home in the 300's if they have no ketones.

:yeahthat: They also have to be symptom-free, but that usually goes hand in hand with ketones. Also, when pts come in with 300's I've seen docs just order a wide open NS IV, check the level again, then give insulin subcu and send them home.

A lot of our patients live in the 300s...and if they're asymptomatic, we also will send them home. And if people are being admitted, we don't always worry about getting their insulin on board. How many times have you heard from family "she's diabetic, she needs to eat" and the pt's BS is over 250? If makes you wonder if people are being taught much about handling their DM.

I over see health issues as they have to do with driving for my state. I do have a problem with people driving with a BS in the 400 and 500 range. Especially commercial drivers. Many of these folks are trying to avoid insulin use as it complicates their commercial license. As a result they are living with a regular BS in the 400+ range. Of course they are losing their kidneys and their vision, their heart and sensation in their legs.....

the docs/nurses in our ed rarely give (much) insulin. they just do the nss wide open thing..............and water down their electrolytes in the process.

i blame the nurses as much as the docs since we know what do to as well.

when they come to my cardiac floor, we inevitably give hefty doses of lantis and correct their electrolytes. i don't get it.

also, another reply mentioned education. i can't agree with that more. pt should not live in the 300's, that is not safe. they need to be educated, I always take the time to find out why people are in the 300's, 500's, 800's. there is usually a reason-like they got kicked out of their house; they're depressed; no money for meds; didn't know or they don't care.

glad somebody brought up this topic, it really irks me, and is one big reason I no longer want to work in an er.

I thought that the responsibility of an emergency department is to stabilize emergencies. Someone with a blood sugar of 300 and no ketones does not sound like an emergency. It sounds like a primary care or endocrine issue. Further more, starting intravenous fluid loading to protect the kidneys in an admitted patient whose dx is hyperglycemia, seems like a safe and responsible order to be started in the ED. Giving boluses of intravenous insulin and causing sudden abrupt shifts in glucose can be very BAD for the brain in someone with a CBG of "800". That is what the ED practitioners leave to the admitting internist to solve. That is also why your cardiac floor will often initiate these insulin gtt orders.

We give NS w/o x 1-2 liters for hyperglycemia. We also usually give 10 units regular insulin IV. And we try and find source of infection if pt has been taking their meds. We had a FF come in almost every other day for a couple of years, walking in with fsbs's of 1500 on a regular basis. We got to watch him slowly kill his kidneys and end up on dialysis. Haven't seen him in a few months, either died, was arrested or moved, probably.