Why do docs give D5 to diabetic patients a lot?

Specialties Med-Surg

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I noticed our docs give D5 to atleast half of our diabetic patients. Can anyone tell me the rationale for this? There bs is usually wnl. :

Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.

I once saw an amp of D5.0 get pushed through a central line during a rapid response.

That wasn't pretty.

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I once saw an amp of D5.0 get pushed through a central line during a rapid response.

That wasn't pretty.

What happened? And why'd they push it?

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Specializes in Med-Surg, Tele, Vascular, Plastics.
What happened? And why'd they push it?

D50 is 50% dextrose as opposed to the D5 which is 5% dextrose...

the D50 should be ordered on a PRN basis for all Diabetics on insulin...

if their BG drops, and they are unresponsive or unable to take food/drink by mouth the D50 which comes in an amp and its very thick and syruppy is pushed rapidly through an IV line... it acts almost instantly to bring blood glucose up in an emergency situation

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Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.

Ick, typo. D50.

And it is VERY thick.

Sorry, I'd been up for 24 hours and I thought the thread said D50 instead of D5. lol

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Specializes in Orthopedics/Med-Surg, LDRP.

I noticed this as well. Just about every patient (with DM or not) has D5 1/2NS or D5NS hanging usually at 100-125ml/hr. I see a lot of DM patients with increased BS on these fluids and once we get an order to change it to 1/2 NS or NSS their BS stabilizes. One endocrinologist said that in the D5 1/2NS/NSS there's like a tablespoon of glucose in the whole bag and that it's not so much for a diabetic, but my evidence based practice shows otherwise. It's perplexing.

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Specializes in medical, surgical, icu, geriatric, pedia.

somehow i can understand why. during my volunteer period i remember myself and my coworkers commenting on why the need for diabetic patients to have a D5W as their mainline IV.

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Specializes in Trauma/ED.

Try pushing D50 into an IO...I built up a sweat! lol

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Specializes in ED/trauma.
It's standard to use D5 for surgical diabetic patients. Due to NPO status, post-op N/V, possible anorexia, and increased caloric need while healing.

The risk for infection is decreased with tighter blood sugar control. Many surgeons will stop oral hypoglycemics and use scheduled and sliding scale insulin.

The D5 only provides 400 calories in 24 hours if going at 100cc/hr. It's not enough to cause hyperglycemia. But is enough to help with the previously listed problems.

This is useful, thanks. I had a teeny old lady who was receiving D5 and not eating much but her BS were always high. The night nurse told me it was because of the D5. I said DUH, like this was revelational! We got it D/C'd. During my shift, I was expecting her BS to be more normal, of course. However, her BS didn't drop much at all. Your response explains why!

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Specializes in Telemetry/Med Surg.
Try pushing D50 into an IO...I built up a sweat! lol

That's for sure! :nuke:

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Specializes in CVICU.
I noticed this as well. Just about every patient (with DM or not) has D5 1/2NS or D5NS hanging usually at 100-125ml/hr. I see a lot of DM patients with increased BS on these fluids and once we get an order to change it to 1/2 NS or NSS their BS stabilizes. One endocrinologist said that in the D5 1/2NS/NSS there's like a tablespoon of glucose in the whole bag and that it's not so much for a diabetic, but my evidence based practice shows otherwise. It's perplexing.

I am in the same boat with you. We run a lot of insulin drips with our sepsis and surgical patients and I have definitely noticed that when a D5 solution is started, blood sugars seem get out of control. It usually seems that they go up by about 50 to 100 mg/dl from my experience.

For example, I've had patients (both diabetic and those on insulin drips for other reasons), and let's say they are to be NPO at midnight. For this example, let's say this patient's blood glucose has been running between 80-120 mg/dl most of the time and they are also on tube feed. At midnight, I shut the tube feed off and start D5 1/2 NS @ 100 ml/hr. At 0100, a blood glucose is obtained it is now 190. I adjust my insulin drip accordingly and another glucose is obtained at 0200. Again, it is above the recommended range, and I have to go up to the next insulin algorithm.

Does this make any sense to anyone? Has anyone else had these types of experiences? At our facility, we have insulin algorithms which are adjusted up or down based on glucoses being in range (between 70-120 mg/dl recommended). We check their glucose hourly until they have been stable on an algorithm for four hours and then we change to every two hour checks. When the doctor orders D5 it seems like it does cause a large deviation from the recommended goal. This is especially bothersome to coherent patients who don't enjoy being poked every hour in the middle of the night.

From what I've been reading, D5 solutions shouldn't cause this issue, but why does it seem like they do?

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