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
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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
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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.
Case Study of Hyperkalemia: George is a 72 year old male found collapsed at home on floor of his bedroom, incontinent of urine and faeces. He complained of significant pain in his right hip with shortening and rotation. George’s family last had contact with George 3 days prior to his collapse. Assessment: On arrival at ED he is confused and combative with a GCS 0f 13 Initial observations reveal BP 78/60; Pulse 74, RR 32, SPO2 91% (NRB 15L) ABG ...
Â· Estimate intravascular volume status (via BUN/Cr, VS, orthostatic BP, urine output, physical exam, HgB)(to estimate saline requirement. Â· Assess free water deficit using corrected serum Na. A. Initial Fluid Orders: I. First correct intravascular fluid volume deficit with normal saline at a rate dependant on severity (being more cautious if cardiac or renal disease) a) 0.9% NaCl at 1-3 Liters /hr (15-20ml/kg) over 1 hour b) Give additional ...
Perioperative tight blood glucose (BG) control using insulin therapy after major surgery is a difficult, time-consuming task that also raises some concerns over the risk of severe hypoglycaemia. The aim of the present prospective study was to evaluate the efficacy and safety of an insulin therapy protocol in use at our institution. A total of 230 consecutive patients (mean±SD age: 67±11 years; diabetic patients: n =62) undergoing cardiac surger ...
Inpatient Glycemic Targets After publication of the initial van den Berghe trial in surgical intensive care patients,1 several professional organizations published guidelines supporting near-normal glycemic targets.8,9 Subsequent trials documented an increased risk for hypoglycemia with tight glycemic control, suggesting that more modest glycemic targets may be optimal.10–13 The Normoglycemia in Intensive Care Evaluation–Survival Using Glucos ...