Nurses Caring for Nondiabetics After an Insulin Injection

[SilverBells, BSN]

As nurses, we often care for patients who are diabetic and take insulin.  However, occasionally we may encounter a nondiabetic who has taken insulin.  Anyone have any experience with this?  What type and amount (approximately anyway) of insulin did your patient take? What was your plan of care? What were the outcomes (e.g did patient make full recovery)? 

[Davey Do]

17 minutes ago, SilverBells said:

 we may encounter a nondiabetic who has taken insulin.  

I found this, SilverBells, on non-diabetic uses of insulin:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354952/#:~:text=Therefore%2C this leads us to,may prove to be fatal.

[Davey Do]

Years ago, I worked with an older nurse who, while in nursing school, witnessed Insulin Shock Therapy for psychotic patients diagnosed with schizophrenia.

https://en.wikipedia.org/wiki/Insulin_shock_therapy

When I was a student/new nurse back in the '80's, an OB supervisor told me she was in nursing school when she heard, on the radio, of the attack on Pearl Harbor. In my first nursing job at an LTC facility, a patient I cared for had been a nurse in the '40's and we talked about the new miracle med penicillin!

[Hannahbanana, BSN, MSN]

Reports of insulin given to nondiabetic patients nowadays tend to be in the context of mass murder in care situations. Here’s just one recent example. Sometimes the perps think it’s a mercy, sometimes they enjoy being part of the rescue. 

https://www.usatoday.com/story/news/nation/2021/05/09/VA-serial-killer-reta-mays-sentenced-Tuesday-seven-deaths/4978545001/

[JBMmom, MSN, NP]

Was the patient accidentally administered insulin? How did it fall into the plan of care? How much insulin was administered and by what route? Was is short or long acting? All these things would play a role in determining outcome. The most common use of insulin in non-diabetic patients that I have encountered is giving regular insulin by IV with dextrose to reduce potassium levels. It's usually 5-10 units regular insulin by IV, we give the sugar at the same time and recheck blood glucose every 15 minutes until it's greater than 100. 

Every unit of insulin should lower blood glucose by 30-100 points, a pretty wide range, so it's hard to know exactly how any individual patient will respond. Certainly checking blood sugar frequently until their levels are stable would be important. As has been pointed out, it can be a fatal outcome, however, it certainly doesn't have to cause any long term negative side effects. 

[harvestmoon, RN]

Pretty much all our patients on TPN get insulin. I had a covid patient on massive steroids getting insulin but she was not diabetic. I've only worked for 3 months but that's what's come up so far.

[harvestmoon, RN]

Pretty much all our patients on TPN get insulin. I had a covid patient on massive steroids getting insulin but she was not diabetic. I've only worked for 3 months but that's what's come up so far. 

so plan was BG q.4 and cover according to protocol. C-19 patient was pretty anxious (and EtOH abuser) so did emotional support and teaching for her. the others (on tpn) are pretty sick and don't really even care about the insulin.

[nursej22, MSN, RN]

I've only seen it used with dextrose infusion to lower serum potassium levels. 

[LovingLife123]

It’s actually pretty common in the ICU.  TPN, tube feeds, steroids, just the basic trauma to the body can make anyone’s numbers go up and require insulin for a short period of time.  An actual diabetic may get levemir added with novolog while others just get sliding scale novolog.  

[AnLe, ASN, RN]

On 5/28/2021 at 11:15 PM, harvestmoon said:

Pretty much all our patients on TPN get insulin. I had a covid patient on massive steroids getting insulin but she was not diabetic. I've only worked for 3 months but that's what's come up so far.

Same in regards to TPN and patients receiving steroids. Another post mentioned IV insulin and IV glucose for potassium shift.