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What Is An Insulin Drip

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What is INSULIN SHOCK THERAPY? What does INSULIN SHOCK THERAPY mean? INSULIN SHOCK THERAPY meaning - INSULIN SHOCK THERAPY definition - INSULIN SHOCK THERAPY explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s. It was one of a number of physical treatments introduced into psychiatry in the first four decades of the twentieth century. These included the convulsive therapies (cardiazol/metrazol therapy and electroconvulsive therapy), deep sleep therapy and psychosurgery. Insulin coma therapy and the convulsive therapies are collectively known as the shock therapies. Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. Patients, who were almost invariably diagnosed with schizophrenia, were selected on the basis of having a good prognosis and the physical strength to withstand an arduous treatment. There were no standard guidelines for treatment; different hospitals and psychiatrists developed their own protocols. Typically, injections were administered six days a week for about two months. The daily insulin dose was gradually increased to 100150 units until comas were produced, at which point the dose would be levelled out. Occasionally doses of up to 450 units were used. After about 50 or 60 comas, or earlier if the psychiatrist thought that maximum benefit had been achieved, the dose of insulin was rapidly reduced before treatment was stopped. Courses of up to 2 years have been documented. After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness. Sopor and comaif the dose was high enoughwould follow. Each coma would last for up to an hour and be terminated by intravenous glucose. Seizures sometimes occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around. Some psychiatrists regarded seizures as therapeutic and patients were sometimes also given electroconvulsive therapy or cardiazol/metrazol convulsive therapy during the coma, or on the day of the week when they didnt have insulin treatment. When they were not in a coma, insulin coma patients were kept together in a group and given special treatment and attention; one handbook for psychiatric nurses, written by British psychiatrist Eric Cunningham Dax, instructs nurses to take their insulin patients out walking and occupy them with games and competitions, flower-picking and map-reading, etc. Patients required continuous supervision as there was a danger of hypoglycemic aftershocks after the coma. In "modified insulin therapy", used in the treatment of neurosis, patients were given lower (sub-coma) doses of insulin. A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80 percent in the treatment of schizophrenia; a few others argued that it merely sped up remission in those patients who would undergo remission anyway. The consensus at the time was somewhere in between - claiming a success rate of about 50 percent in patients who had been ill for less than a year (about double the spontaneous remission rate) with no influence on relapse. Sakel suggested the therapy worked by "causing an intensification of the tonus of the parasympathetic end of the autonomic nervous system, by blockading the nerve cell, and by strengthening the anabolic force which induces the restoration of the normal function of the nerve cell and the recovery of the patient." The shock therapies in general had developed on the erroneous premise that epilepsy and schizophrenia rarely occurred in the same patient. Another theory was that patients were somehow "jolted" out of their mental illness.

Intravenous Insulin Therapy

Patients with hyperglycemia in the ICU have increased morbidity and mortality. Hyperglycemia is associated with immune dysfunction, increased systemic inflammation, and vascular insufficiency. Elevated blood glucose levels have been shown to worsen outcomes in medical patients who are in the ICU for more than 3 days. Hyperglycemia may result from stress, infection, steroid therapy, decreased physical activity, discontinuation of outpatient regimens, and nutrition. [ 1 ] Improved control of hyperglycemia improves patient outcomes, but clinical confirmation of this thesis has proven elusive. Significant interest was generated by initial single-center results that have not been replicated in multisite studies. In 2001, a randomized controlled study in a surgical ICU demonstrated a decrease in mortality from 8% to 4.6% in patients with intensive continuous intravenous insulin therapy. [ 2 ] The author repeated the protocol in a study of 1200 patients in a medical ICU. [ 3 ] The conventional treatment group was treated to maintain a blood glucose level between 180-200 mg/dL, whereas the intensive treatment group was treated to maintain a blood glucose level between 80-110 mg/dL. Mortal Continue reading >>

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  1. MLB55

    Quote from H_2_O
    I'm about halfway through my first year in the ICU at a community hospital and have had a few patients on insulin drips for various reasons over the past couple of weeks. As a new grad, I'm always trying to learn, and always wanting to make sure I know why I'm doing something. So I'm always asking questions and fortunately, coworkers are very helpful.However, the issue that has seem to come up with insulin drips lately is something it seems nobody in the unit understands or can explain, and has me questioning if some of the physicians even really know what they're doing.The issue revolves mostly around the actual purpose of the insulin drip, and whether or not patients on an insulin drip are allowed to eat.I'll try to briefly explain two scenarios:Example 1: 32y/o type 1 diabetic turned off his insulin pump while sick. Arrived in DKA with sugars in the 600s and on an insulin drip running at a constant rate of 5 units/hr. Doctor called later to see if the pt. is "ok," didn't even ask what his sugars were (they were running 200s to 300s) and said to start him on an 1800 ADA diet. Later the doc shows up and tells me he doesn't care about the sugars, just the acidosis (which had been resolving). He told me in DKA the insulin drip is just for the acidosis, not the sugars. Pt. went home with sugars under control and normal acetones later that night.Example 2: 72 y/o COPD'er that was started on 40 of IV solumedrol, sending his sugars into the 500s. Patient was put on our insulin drip protocol, which is rather confusing and assumes the patient is NPO. Sugars are down to 169 after being 200-300 all day (so he's almost off the drip). Primary doc arrived and said continue with the insulin drip, then put him on sliding scale when he's below 140 for two hours. When the pulmonologist arrives shortly after, and the patient begins complaining to him that I'm "starving" him by keeping him NPO. Pulmonologist then tells me to start him on an 1800 ADA or he's "going to go hypoglycemic and code" and "he will die". Cuts the solumedrol down to 20 but leaves me out to dry as far as the insulin drip goes and hurriedly runs out the door. So I call the primary, tell him what pulmonary said. He says OK, put him on medium dose sliding scale with q3h cbgs and let him eat. Three hours later he has a sugar of 453. I call the primary and he said to go ahead and give 20 units per sliding scale and check him again in 3 hrs. This was right before shift change so no idea what happened later...Also, what about giving lantus while on an insulin drip? Some say yes, some say never.My coworkers, some who have 30+ years ICU experience in major hospitals, all tell me they have never have a clue what the heck these doctors are doing with their insulin drips and that it defies logic - especially when it comes to eating on the drip. They tell me that in the old days, patients on insulin drips were ALWAYS npo.Any explanations out there??? I've been in neuroICU for 2 yrs, and anytime they order a diet they switch them over to lantus daily and humalog qMeal + appropriate sliding scale for extra coverage. Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival)

  2. H_2_O

    Quote from MLB55
    Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival) Or is it someone on a drip does not need to be eating?
    The hospital is a small community hospital serving mostly upper middle/upper class patients.
    No residents, interns, etc. Only docs, NPs, PAs. And wow about the D5.

  3. MLB55

    I don't see alot of dka, again I work in neuro and we use GTTs for tight glucose control in any sort of head injury. We use GTTs when pts are being fed enterally, continuously. It can be hard/unsafe to manage a pts bs when they are eating meals and titrating insulin.I'm not sure what the answer is for a pt in dka and should or should not be eating. If a pt can eat on their own, we cut the drip and start lantus and humalog.

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This video includes the best research paper topics that I've ever seen as a professor (along with a tutorial on how to write great argumentative research topics of your own), and here is the link to the webpage featured in the video, including the top 100 topic ideas: http://robjohnfrank.com/research-pape... The research essay topics presented here are intended for college courses, though they could also be used at the high school level, and they are based on some of the most interesting argumentative research paper topics from my English 101 classes and Research Writing classes when I was teaching college courses. The topic examples are broken down by major, including psychology, business, science, and a lot more. If you found this video to be helpful, please Like It, Share It, Comment, and Subscribe to my Channel: http://www.youtube.com/subscription_c... If you want to learn the how to format a paper in MLA using OpenOffice, which is a free alternative to Microsoft Word, I've created this video as well, including a free formatting template for MLA format in both Word 2010 and Open Office, so that you don't have to worry about proper research paper format, including how to set up the MLA title page: https://www.youtube.com/watch?v=kw9Mb... My Google+ Page: https://plus.google.com/1048309663182... Thank you for watching, and I hope this video helps you to write an amazing research paper!

Insulin Therapy - An Overview | Sciencedirect Topics

Regular insulin is a crystalline zinc insulin preparation, the effect of which appears within 30 minutes of subcutaneous injection. Mark A. Atkinson*, in Williams Textbook of Endocrinology (Thirteenth Edition) , 2016 Regular insulin consists of zinc-insulin crystals dissolved in a clear fluid. After subcutaneous injection, regular insulin tends to dissociate from its normal hexameric form, first into dimers and then into monomers; only the monomeric and dimeric forms can pass through the endothelium into the circulation to any appreciable degree.309 This feature determines the pharmacokinetic profile of regular insulin. The resulting relative delay in onset and duration of action of regular insulin limits its effectiveness in controlling postprandial glucose and results in dose-dependent pharmacokinetics, with a prolonged onset, peak, and duration of action with higher doses. Thundiparambil Azeez Sonia, Chandra P. Sharma, in Oral Delivery of Insulin , 2014 Capsulin is an oral insulin formulation developed by a UK-based company named Diabetology. The dry powder mixture, which contains insulin, stabilizer and solubilizer, is packaged in an enteric-coated capsule (with 150U) that pro Continue reading >>

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Popular Questions

  1. MLB55

    Quote from H_2_O
    I'm about halfway through my first year in the ICU at a community hospital and have had a few patients on insulin drips for various reasons over the past couple of weeks. As a new grad, I'm always trying to learn, and always wanting to make sure I know why I'm doing something. So I'm always asking questions and fortunately, coworkers are very helpful.However, the issue that has seem to come up with insulin drips lately is something it seems nobody in the unit understands or can explain, and has me questioning if some of the physicians even really know what they're doing.The issue revolves mostly around the actual purpose of the insulin drip, and whether or not patients on an insulin drip are allowed to eat.I'll try to briefly explain two scenarios:Example 1: 32y/o type 1 diabetic turned off his insulin pump while sick. Arrived in DKA with sugars in the 600s and on an insulin drip running at a constant rate of 5 units/hr. Doctor called later to see if the pt. is "ok," didn't even ask what his sugars were (they were running 200s to 300s) and said to start him on an 1800 ADA diet. Later the doc shows up and tells me he doesn't care about the sugars, just the acidosis (which had been resolving). He told me in DKA the insulin drip is just for the acidosis, not the sugars. Pt. went home with sugars under control and normal acetones later that night.Example 2: 72 y/o COPD'er that was started on 40 of IV solumedrol, sending his sugars into the 500s. Patient was put on our insulin drip protocol, which is rather confusing and assumes the patient is NPO. Sugars are down to 169 after being 200-300 all day (so he's almost off the drip). Primary doc arrived and said continue with the insulin drip, then put him on sliding scale when he's below 140 for two hours. When the pulmonologist arrives shortly after, and the patient begins complaining to him that I'm "starving" him by keeping him NPO. Pulmonologist then tells me to start him on an 1800 ADA or he's "going to go hypoglycemic and code" and "he will die". Cuts the solumedrol down to 20 but leaves me out to dry as far as the insulin drip goes and hurriedly runs out the door. So I call the primary, tell him what pulmonary said. He says OK, put him on medium dose sliding scale with q3h cbgs and let him eat. Three hours later he has a sugar of 453. I call the primary and he said to go ahead and give 20 units per sliding scale and check him again in 3 hrs. This was right before shift change so no idea what happened later...Also, what about giving lantus while on an insulin drip? Some say yes, some say never.My coworkers, some who have 30+ years ICU experience in major hospitals, all tell me they have never have a clue what the heck these doctors are doing with their insulin drips and that it defies logic - especially when it comes to eating on the drip. They tell me that in the old days, patients on insulin drips were ALWAYS npo.Any explanations out there??? I've been in neuroICU for 2 yrs, and anytime they order a diet they switch them over to lantus daily and humalog qMeal + appropriate sliding scale for extra coverage. Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival)

  2. H_2_O

    Quote from MLB55
    Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival) Or is it someone on a drip does not need to be eating?
    The hospital is a small community hospital serving mostly upper middle/upper class patients.
    No residents, interns, etc. Only docs, NPs, PAs. And wow about the D5.

  3. MLB55

    I don't see alot of dka, again I work in neuro and we use GTTs for tight glucose control in any sort of head injury. We use GTTs when pts are being fed enterally, continuously. It can be hard/unsafe to manage a pts bs when they are eating meals and titrating insulin.I'm not sure what the answer is for a pt in dka and should or should not be eating. If a pt can eat on their own, we cut the drip and start lantus and humalog.

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Insulin Drips Flashcards | Quizlet

250 units of regular insulin in 250 ml of 0.9% NS (1:1) 125 units of regular insulin in 250 ml of 0.9% NS (0.5:1) the drip is then piggybacked into an IV fluid line 3.) rate is controlled by infusion pump which can be adjusted as directed. 2.) Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) secondary to prolonged hyperglycemia 3.) both syndromes are life threatening and treated similarly 4.) complications that result from Insulin deficiency in Type 1 and Type 2 Diabetes. 5.) treatment must be provided to correct ACUTE care needs of pt. 2.) illness, infection, or stress in known diabetic pt 3.) provide adequate Insulin to restore and maintain normal glucose metabolism 1.) adequate fluid replacement is crucial for treatment of high glucose levels 3.) hyperglycemia will persist if pt is not properly hydrated. Even if proper insulin therapy is provided. 4.) Admin Insulin alone without appropriate fluid replacement may not be effective in lowering serum glucose levels. 1.) IV fluid must be changed to an IV containing GLUCOSE when serum blood levels decrease to 300mg/dl 2.) crabby, irritable, inappropriate responses, confused, & uncoordinated. Continue reading >>

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  1. MLB55

    Quote from H_2_O
    I'm about halfway through my first year in the ICU at a community hospital and have had a few patients on insulin drips for various reasons over the past couple of weeks. As a new grad, I'm always trying to learn, and always wanting to make sure I know why I'm doing something. So I'm always asking questions and fortunately, coworkers are very helpful.However, the issue that has seem to come up with insulin drips lately is something it seems nobody in the unit understands or can explain, and has me questioning if some of the physicians even really know what they're doing.The issue revolves mostly around the actual purpose of the insulin drip, and whether or not patients on an insulin drip are allowed to eat.I'll try to briefly explain two scenarios:Example 1: 32y/o type 1 diabetic turned off his insulin pump while sick. Arrived in DKA with sugars in the 600s and on an insulin drip running at a constant rate of 5 units/hr. Doctor called later to see if the pt. is "ok," didn't even ask what his sugars were (they were running 200s to 300s) and said to start him on an 1800 ADA diet. Later the doc shows up and tells me he doesn't care about the sugars, just the acidosis (which had been resolving). He told me in DKA the insulin drip is just for the acidosis, not the sugars. Pt. went home with sugars under control and normal acetones later that night.Example 2: 72 y/o COPD'er that was started on 40 of IV solumedrol, sending his sugars into the 500s. Patient was put on our insulin drip protocol, which is rather confusing and assumes the patient is NPO. Sugars are down to 169 after being 200-300 all day (so he's almost off the drip). Primary doc arrived and said continue with the insulin drip, then put him on sliding scale when he's below 140 for two hours. When the pulmonologist arrives shortly after, and the patient begins complaining to him that I'm "starving" him by keeping him NPO. Pulmonologist then tells me to start him on an 1800 ADA or he's "going to go hypoglycemic and code" and "he will die". Cuts the solumedrol down to 20 but leaves me out to dry as far as the insulin drip goes and hurriedly runs out the door. So I call the primary, tell him what pulmonary said. He says OK, put him on medium dose sliding scale with q3h cbgs and let him eat. Three hours later he has a sugar of 453. I call the primary and he said to go ahead and give 20 units per sliding scale and check him again in 3 hrs. This was right before shift change so no idea what happened later...Also, what about giving lantus while on an insulin drip? Some say yes, some say never.My coworkers, some who have 30+ years ICU experience in major hospitals, all tell me they have never have a clue what the heck these doctors are doing with their insulin drips and that it defies logic - especially when it comes to eating on the drip. They tell me that in the old days, patients on insulin drips were ALWAYS npo.Any explanations out there??? I've been in neuroICU for 2 yrs, and anytime they order a diet they switch them over to lantus daily and humalog qMeal + appropriate sliding scale for extra coverage. Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival)

  2. H_2_O

    Quote from MLB55
    Someone that's eating does not need a gtt. What kind of facility do you work in? Are there residents? I work in a large teaching hospital and the mICU team are all fresh interns and have no idea, the other day they had a pt with bs in the 800s on insulin gtt and d5. (this was not my pt, and the d5 was turned off upon day shift arrival) Or is it someone on a drip does not need to be eating?
    The hospital is a small community hospital serving mostly upper middle/upper class patients.
    No residents, interns, etc. Only docs, NPs, PAs. And wow about the D5.

  3. MLB55

    I don't see alot of dka, again I work in neuro and we use GTTs for tight glucose control in any sort of head injury. We use GTTs when pts are being fed enterally, continuously. It can be hard/unsafe to manage a pts bs when they are eating meals and titrating insulin.I'm not sure what the answer is for a pt in dka and should or should not be eating. If a pt can eat on their own, we cut the drip and start lantus and humalog.

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