insulin regime

talaxandra · Feb 20, 2009

Gelofusin is weird - we always use N/Saline as the dilutent. If you find out what the rationale is I'd love to hear it

truern · Feb 20, 2009

Was the patient hypotensive?

talaxandra · Feb 20, 2009

Even if they were, infusing Gelo at a rate of

coffeekat · Feb 21, 2009

the patient is not hypotensive, admit for adjusting insulin dose as poor DM control. When infusing Actrapid+Gelo, we ve to take Q2H h'stix to see the blood glucose level so as to adjust the dose of insulin of the Basal-bolus regime

coffeekat · Feb 21, 2009

but i just dont know why add to Gelo ?

suni, BSN, RN · Feb 21, 2009

I have never heard of either of these, p[lease explain.

talaxandra · Feb 21, 2009

Suni: when a patient is acutely unwell and has unstable blood sugar control (in ICU this covers a lot of patients, on the ward it's usually restricted to T1DM's or really unstable T2's), the patient is commenced on a short-acting (Actrapid, Novorapid) insulin infusion. The infusion rate is titrated to the BSL, which is monitored frequently (1/24 at my hospital, 2/24 at coffeekat's), to maintain tighter glycemic control.

Usually the insulin is diluted to 1 unit/ml in N/Saline. For some reason this infusion was made up in Gelofusine instead of N/S and coffeekat was wondering what the rationale was. So far the consensus is that none of us have any idea.

Incidentally, always make up the infusion in a syringe, not a flask, and use minimum volume tubing as the plastic absorbs insulin, reducing its effectiveness. I've received patients with Actrapid running at 16 units/hr via a flask, with BSL's rising, and switched to a syringe - an hour or two later, at 5 units/hr, the BSL's trending down to normal

coffeekat · Feb 23, 2009

Dear all,

I have asked some RNs about why added to Gelofusine, and they said that its because the insulin is being absored in the plastics tubing of IVset tubings as what talaxandra said. So Gelofusine is act like vehicle solution to enchance the effect of the insulin .

and i hve found a article which is similar to this situation . http://ndt.oxfordjournals.org/cgi/content/full/18/8/1677

talaxandra · Feb 25, 2009

I think I'd still rather use a syringe, though!

jennfinn · Feb 25, 2009

I know this is a little off subject, but have ya'll ever seen a pt with a glucose reading of 2500? another student in post reports said that her pt was in our facility from a 3 week coma due to hyperglycemia, could this reading be correct?

talaxandra · Feb 27, 2009

It's possible, but way high. The highest reading I've had on a patient of mine was 120.8mmol/L (2174.4mg/DL) - she had started to trend high and treated her thirst with flavoured milk and fruit juice, which is how her BSL could be so high without killing her: a chunk of that sugar was exogenous. The story on your patient would be fascinating.