Need help understanding an insulin drip

ahicks · Mar 19, 2011

I think I need more info. Was the patient admitted with DKA?

KD CVICU-RN · Mar 19, 2011

No, just standard Endotool for a post-op pt. that isn't NPO. I understand that they need some form of sugar, but if we are trying to keep tight parameters on their blood glucose post-op, why would we give dextrose on top of the insulin? The orders read, continue D10W @ 30mL/hr if BG

Biffbradford · Mar 30, 2011

Well, everybody's Insulin protocol is different, and every surgeon has their own preferences. If the patient was a fresh post-op, then perhaps they just wanted to make sure they didn't bottom out from the drip. Look closely at the patient's history, that might give you some clues.

msmiranda21 · Mar 31, 2011

Lacking more information to answer your question....

cwhitebn · Apr 21, 2011

I think sometimes you hang D10W with insulin drip so the pt won't go hypoglycemic. Not 100% sure but I think I heard something along those lines once lol.

akulahawkRN, ADN, RN, EMT-P · May 1, 2011

I'm not an RN, nor am I familiar with the Endotool... but I think I've got a handle on this.

A quick review of this topic and my own knowledge of insulin/glucose leads me to exactly the same conclusion - it's precisely to keep the patient from going hypoglycemic. As the Endotool is a computerized insulin therapy system that adapts to a patient's blood glucose levels, it isn't able to instantly stop insulin that's already in the body from continuing to work if glucose levels suddenly drop off and there's no glucose source available to bring the level back up. I imagine that the system is certainly capable of controlling insulin infusion rates, so there's either a steady-state D5 or D10 infusion going OR the system can control both infusion rates.

To me, it makes sense to control both the insulin and a source of glucose. You use the insulin to keep the glucose level from going too high and the glucose in the IV fluid to keep the level from going too low. Ideally, you'll eventually end up with a very tight control over blood glucose levels because you're basically controlling BOTH sides of the problem. If the patient is not NPO and consumes some amount of carbohydrate, in the short term, you'd see that glucose level spike and the Endotool will adjust by providing more insulin and as glucose levels drop off, so will the rate of insulin infusion, but circulating insulin will still be doing "it's thing" while the D10 provides a backstop against hypoglycemia.

I'm just a well-educated pre-nursing student.

cjcsoon2bnp, MSN, RN, NP · May 11, 2011

How are their Potassium levels? I know that an insulin drip running with D10W into the same pt. is often a treatment for hyperkalemia. Any chance they would be using the insulin drip for that?

!Chris :specs:

ckh23, BSN, RN · May 17, 2011

If you have IV insulin infusing you need to have some type of dextrose going IV, whether it is D10, D5 1/2, TPN, etc. The reason is to prevent hypoglycemia. The effect of IV insulin is very quick and without some type of dextrose your patient can go hypoglycemic quickly. Even if the patient is eating regularly, what happens to the BS when they are not? They go hypoglycemic.

NAURN · May 26, 2011

We use endotool as well, and some of the drs choose not to use the d10... actually the majority of them. For DKA, you need to feed the body insulin to correct the problem, so there is a reason for dextrose in those patients, but your run of the mill hyperglycemics that are put on insulin drips, we don't use the d10

RN-LOGIC · Aug 1, 2011

I think that is hilarious when nurses freak out cause they see a diabetic patient receiving some kind d5 or d10w in this case. First ask yourself what 1 liter D10W is? it means that you have 10 percent of dextrose in water. In this case going at a rate of 30 ml/hr which means that you will be getting this 10 percent of d10w at a rate of 30 ml/hr over a day. If you ask me. its not significant at all.

Esme12, ASN, BSN, RN · Aug 2, 2011

I think that is hilarious when nurses freak out cause they see a diabetic patient receiving some kind d5 or d10w in this case. First ask yourself what 1 liter D10W is? it means that you have 10 percent of dextrose in water. In this case going at a rate of 30 ml/hr which means that you will be getting this 10 percent of d10w at a rate of 30 ml/hr over a day. If you ask me. its not significant at all.

One liter of D10.........340 calories/1000cc's.......not significant but prevents hypoglycemia.:)