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What Is An Insulin Drip

A Nurse's Guide To Administering Iv Insulin

A Nurse's Guide To Administering Iv Insulin

You have a patient that comes up to your unit with a blood sugar of 952. The labs are sent off and the patient is found to be in severe diabetic ketoacidosis (DKA). The doctor puts in the orders for serial lab work, fluid boluses, electrolyte replacements, and an insulin drip. As a newer nurse, you are familiar with labs, boluses, your replacement protocols, but have never administered insulin through an IV. What nursing interventions do you need to perform to safely care for this patient? How Does Insulin Work? Insulin is a hormone created by the pancreas. It allows your body to use glucose to provide the body's cells with the necessary energy they need. Insulin production from the pancreas is based off of your blood sugar levels. If you are getting hyperglycemic, the pancreas is signaled and insulin is released into the bloodstream. Insulin then signals different cells to absorb the glucose and use it as energy or store it for later use. When insulin facilitates glucose being pulled into a cell, a potassium cation is also pulled from extracellular fluid (meaning the bloodstream) into the intracellular fluid. How does this affect our patients? Initially, patients in DKA have an increased extracellular potassium level due to the hyperglycemia and acidosis they are experiencing. This potassium level is quickly decreased as blood glucose is pulled into the cells. Administration As with all critical care medications, be sure to check your hospital's policy for administration. I have seen two main situations in which IV insulin (meaning regular insulin, not Lantus, Aspart, etc.) is given. Treatment of DKA: It seems like each hospital has a different protocol they use to manage DKA patients with. Commonly patients are treated with a bolus of regular insulin IV and then place Continue reading >>

Intravenous Insulin Therapy

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. Mortality was not significantly reduced by intensive insulin therapy and was actually higher in patients in the intensive treatment group who were in the ICU for less than 3 days. In patients who were in the ICU for longer than 3 days, the intensive treatment group did demonstrate reduced morbidityfrom decreased kidney injury, earlier weaning from mechanical ventilation, and earlier discharge from the medical ICU and hospital. Hypoglycemia occurred more often in the intensive treatment group than the conventional treatment group. In addition, an experienced physician was actively involved in adminis Continue reading >>

What To Expect In The Hospital

What To Expect In The Hospital

“The wish for healing has ever been the half of health.” —Seneca the Younger Most people experience a stay in the hospital at least once in their lives, and for some, it is much more often than that. No matter what the reason for your admission to the hospital, it is imperative that your blood glucose levels be controlled while you are there. More and more research shows that maintaining optimal blood glucose control in the hospital improves a person’s chances of having the best possible medical outcome. However, achieving optimal control in the hospital is a challenge. Stress tends to raise blood glucose level, and in the hospital, the stresses are many: Illness itself is a physical stress, as are pain, surgery, and other medical procedures such as having blood drawn for tests. Simply being in the hospital is a physical and mental stress with all of the changes in routine. And worrying about the reason you’re in the hospital, whether your diabetes is being controlled properly, how much the hospitalization is going to cost you, how your family or job is making out without you, etc., simply adds to it. If your hospital admission is not an emergency, you and your health-care provider have more time to prepare so that some of the stress of being in the hospital can be minimized. For example, you can establish ahead of time whether your personal physician will be overseeing your care while you’re in the hospital or, if not, who will. You can also discuss how your diabetes will be controlled and whether and when to stop taking any medicines you may currently take. And you can make plans for dealing with such personal responsibilities as child care or pet care during your hospital stay. If you are admitted to the hospital through the emergency room, it is standard Continue reading >>

Insulin Drips Flashcards | Quizlet

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 >>

Continuous Intravenous Insulin: Ready For Prime Time

Continuous Intravenous Insulin: Ready For Prime Time

Abstract In Brief Hyperglycemia in the inpatient setting has been linked to poor outcomes. There is evidence that careful management of hyperglycemia in the acute care setting can decrease lengths of stay, morbidity, and mortality. In unstable, critically ill patients, blood glucose excursions are most effectively controlled through the use of continuous intravenous insulin infusion protocols. However, barriers remain to the acceptance and successful implementation of protocol-driven initiatives to achieve normoglycemia. A multidisciplinary team approach can help overcome staff misconceptions and fears regarding tight glycemic management in hospitalized patients. Rationale for Continuous Insulin Infusion Stress-induced hyperglycemia is a commonly encountered problem in the acute-care setting. Elevated blood glucose levels in critically ill patients may result from the presence of excessive counterregulatory hormones and high levels of tissue and circulating cytokines. These metabolic changes can result in increased insulin resistance and a failure to suppress hepatic gluconeogenesis. Thus, hyperglycemia may be present even in inpatients without a diagnosis of diabetes. Studies have shown an association between hyperglycemia and an increased risk of infection, sepsis, renal failure, congestive heart failure, stroke, and neuropathy.1–6 The recognition of hyperglycemia as a contributor to poor outcomes has provided the rationale to pursue tight glycemic control. The key to effectively controlling hyperglycemia is to identify early patients who have or are at risk of developing elevated blood glucose levels and to initiate appropriate therapy in a timely manner to maintain near-normoglycemia. Insulin is the therapy of choice for management of hyperglycemia in hospitalized Continue reading >>

Inpatient Insulin Therapy: Benefits And Strategies For Achieving Glycemic Control: Achieving Intensive Glycemic Control: Inpatient Protocols And Outcomes

Inpatient Insulin Therapy: Benefits And Strategies For Achieving Glycemic Control: Achieving Intensive Glycemic Control: Inpatient Protocols And Outcomes

Achieving Intensive Glycemic Control: Inpatient Protocols and Outcomes You have to know the hemoglobin A1C. If the patient is above 110 mg/dL and ill, meaning a cardiothoracic surgery patient or anybody in the critical care unit, you start an insulin drip automatically. You just call the doctor and say the patient is on the intravenous (IV) insulin protocol. If the patient is on the floor and their sugar is above 140 mg/dL and it stays above 140 mg/dL, you automatically start basal bolus insulin therapy. If it stays above 140 mg/dL and you can't get control, you automatically go to an insulin drip. Find out how much insulin you need, then go back to basal bolus therapy. It's that simple and easily done. Special Situations for Specific Protocols These are the key elements we need; this information is being published. You have to go along with the guidelines by the American Diabetes Association (ADA) and American College of Endocrinology (ACE). They have to be simple and user friendly, meaning easily done. You have to identify patients needing initiation or modification of insulin treatment. You have to understand that you just can't tell somebody to do it -- you've got to tell them how to do it. You have to teach nursing staff, pharmacy, and others how to do this and how to double check to make sure everything is done appropriately. Then all of a sudden you have 30%, 40% of your patients in the hospital on insulin. You have a hemoglobin A1C, then you have to decide what to send them home on. We clearly feel that if A1C is above 7%, you send them home on basal bolus therapy -- no question. If it is in the gray zone of 6%-7%, then that is up to the healthcare provider and we do that accordingly. That is why we use the A1Cmeasurement -- it is very important. There are guid Continue reading >>

Insulin Drip In Euglycemic Ketoacidosis - A Tough Nut To Crack!

Insulin Drip In Euglycemic Ketoacidosis - A Tough Nut To Crack!

Abstract: This abstract also was presented at the 15th annual Rachmiel Levine Diabetes and Obesity Symposium on March 2, 2015, Levine Poster Number: 39. Background: Metabolic ketoacidosis has been frequently associated with three major etiologies which include diabetes, alcohol and starvation. Treatment is tailored towards the cause and usually involves crystalloid infusion in alcohol and starvation ketosis and implementation of insulin drip in diabetic ketoacidosis[1]. On the contrary our patient presents with a challenging scenario which warrants further insight to the treatment strategies of metabolic ketoacidosis. Clinical Case: A 59-year-old male with past medical history of diabetes and alcoholism presented to the ER with coffee ground emesis for 3 days. One week prior to admission the patient fell off the stairs and injured his left shoulder. Thereafter he consumed alcohol for pain relief and had not eaten anything. He admits to not taking his insulin for last 2 days. Upon admission vitals were stable. His labs were significant for Hb- 10.4 (n 11.6-16.8) g/dL, INR- 1.0 (n 0.9-1.1), blood glucose- 106 (n 70-115) mg/dL, BUN- 15 (n 6-20) mg/dL, Cr- 0.6 (n 0.7-1.2) mg/dL, Na- 133 (n 136-145) mmol/L, K- 3.1(n 3.6-5.1) mmol/L, Cl- 84 (n 90-110) mmol/L, HCO3- 16 (n 22-28) mmol/L, AG- 34 (n 2.6-10.6) mmol/L, B-Hydroxy > 8 (n <0.3) mmol/L -, Lactic Acid- 1.3 (n 0.5-2.2) mmol/L, Serum Osm- 311 (n 280-290) mOsm/Kg . Urine was positive for ketones. PH- on ABG was 7.29 (n 7.350-7.450). Alcohol level was 211(n 0-10) mg/dL. Urine Drug Screen was negative for drugs. Since the patient was euglycemic, IV insulin drip was not initiated and he was presumably treated for starvation and alcohol ketoacidosis with multivitamins , thiamine and D5NS @ 150 mL/hour. Patient was kept NPO, fi Continue reading >>

In-hospital Management Of Patients With Hyperglycemia: Transitioning From Iv Insulin Therapy To Subcutaneous Insulin Regimens And Effective Discharge Planning To Maintain Glycemic Control (an Interactive Case Study)

In-hospital Management Of Patients With Hyperglycemia: Transitioning From Iv Insulin Therapy To Subcutaneous Insulin Regimens And Effective Discharge Planning To Maintain Glycemic Control (an Interactive Case Study)

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [emailprotected] Instructions for Participation and Credit There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. Follow these steps to earn CME/CE credit*: Read the target audience, learning objectives, and author disclosures. Study the educational content online or printed out. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage. *The credit that you receive is based on your user profile. (For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: [emailprotected] . For technical assistance, contact [emailpro Continue reading >>

Iv Insulin On The Floor: Not So Scary After All

Iv Insulin On The Floor: Not So Scary After All

Published in the October 2010 issue of Today’s Hospitalist When it comes to transitioning patients with severe hyperglycemia away from sliding scale insulin, physicians are often blamed for refusing to embrace a better way of doing things. But many hospitalists who are moving to standardize subcutaneous insulin protocols won’t even consider using an insulin drip outside of the ICU. The reason they often shy away from insulin infusion on the floor, even for patients about to receive a procedure, is that nurses simply don’t have the time to do the monitoring (and math) necessary to safely keep ward patients on a drip for a day or two. And if nurses don’t have enough time to monitor patients, an insulin drip protocol could be disastrous. But there’s now some evidence that continuous insulin infusion protocols outside the ICU are not only safe and effective, but that physicians and nurses alike embrace them “if implemented properly. The Emory Healthcare System in Atlanta is a case in point. “A sizeable number of insulin infusions are given to patients before, during or after a procedure.” ~ Noble Maleque, MD Emory University Hospital Midtown A study conducted at the system’s flagship Emory University Hospital looked at the safety and efficacy of a continuous insulin infusion protocol. Researchers analyzed more than 200 patients in a 12-month period who received insulin infusion on the floors. The study, published in the April 2010 Journal of Hospital Medicine, found that the rate of hypoglycemic events among those patients was similar to research findings on subcutaneous insulin regimens. A similar protocol has been in place for the better part of 10 years at Emory University Hospital Midtown, a 511-bed teaching hospital in midtown Atlanta. As hospitalists Continue reading >>

Variable Rate Insulin Infusion

Variable Rate Insulin Infusion

Regular Insulin 100 units in 100 cc NS (1 u per 1 ml) Type II Diabetic or poor control: 2-3 units per hour Weight-based (use true weight, not Ideal Weight ) Consider starting with this dose in very large patients with high calculated doses Insulin bolus prior to starting Insulin Drip is controversial Use in adult Diabetic Ketoacidosis does not offer additional benefit over Insulin Infusion alone Coadminister D5W at 100 to 125 cc per hour Check Blood Glucose every 30 minutes to 1 hour Give 25 ml of D50 IV (or 10-12 grams Glucose ) Continue q2 hour Blood Glucose Monitoring Restart Insulin Drip when Blood Glucose >150 V. Discontinuation (e.g. Postoperatively) Administer patient's usual Insulin dose pre-meal Discontinue Insulin Infusion two hours after meal Marks (2003) Am Fam Physician 67(1):93-100 [PubMed] Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Variable Rate Insulin Infusion." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism. protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the reg Continue reading >>

Subcutaneous Insulin In Dka: Safe — But Not Better Than Iv Insulin

Subcutaneous Insulin In Dka: Safe — But Not Better Than Iv Insulin

Diabetic ketoacidosis (DKA) remains one of the more serious complications of diabetes. DKA management usually involves the continuous infusion of intravenous regular insulin, as recommended by both the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Subcutaneous insulin may be cutting edge in the treatment of diabetics, but studies show that its benefits over old fashioned IV insulin are marginal at best. Diabetic ketoacidosis (DKA) remains one of the more serious complications of diabetes. DKA management usually involves the continuous infusion of intravenous regular insulin, as recommended by both the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Studies conducted in the 1970s and 1980s demonstrated the superiority of IV regular insulin over subcutaneous (SC) or intramuscular (IM) regular insulin, with a more rapid initial decrease in plasma glucose and ketone levels observed (Fisher 1977). These observations are likely due to the relatively prolonged half-life of SC and IM regular insulin. Newer, rapid-acting insulin analogues (aspart and lispro) offer the advantage of having much shorter half-lives than regular insulin, and their efficacy in the management of DKA, when administered subcutaneously, is worth reviewing. The main issue with IV insulin drips is that, in most institutions, their use requires admission to an ICU setting. Unfortunately, as our patient population ages and as life-prolonging treatments become more commonplace, ICU beds are getting harder to come by. As a result, DKA patients are sometimes managed in the emergency department until their anion gap closes and the insulin drip can be turned off. Management of such patients in the ED ties up pre Continue reading >>

Transitioning Safely From Intravenous To Subcutaneous Insulin

Transitioning Safely From Intravenous To Subcutaneous Insulin

Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention. Common hospital uses for IV insulin include the perioperative setting, during the use of high-risk medications (such as corticosteroids), or during crises such as diabetic ketoacidosis (DKA) [1,2]. Other conditions such as hyperglycemic hyperosmolar state (HHS) and trauma frequently require IV insulin, as well as specific hospital units such as the cardiothoracic intensive care unit [3,4]. The correlation between hyperglycemia and poor inpatient outcomes has been well described in the literature [5,6]. The treatment of hyperglycemia using an IV Continue reading >>

Insulin Therapy - An Overview | Sciencedirect Topics

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 protects the insulin from gastric degradation. The capsule is declared to pass intact through the stomach to the small intestine. The coating dissolves in the jejunum in an area with neutral pH, and the capsule content is subsequently released. The excipients (an aromatic alcohol and a solubilization aid) are supposed to enhance insulin absorption through the intestinal mucosal layer. Diabetology has performed some early clinicalexperimental proof-of-concept studies in healthy subjects and patients with type 1 diabetes, and more recently a phase IIa randomized, open, crossover study in 16 patient Continue reading >>

Hyperglycemia And Switching To Subcutaneous Insulin

Hyperglycemia And Switching To Subcutaneous Insulin

Hyperglycemia and Switching to Subcutaneous Insulin A 47-year-old man with type 2 diabetes was admitted to the hospital with nonketotic hyperglycemia due to medication nonadherence. He was placed on a transitional care (step-down) unit and the decision was made to start an intravenous (IV) insulin drip to control his hyperglycemia. This hospital used the Glucommandera computer-based system that recommends insulin and IV fluid infusion rates based on the patient's blood glucose levelsfor protocol-based management of hyperglycemia. The admitting physician entered initial orders into the Glucommander, and the system recommended changes to the infusions based on subsequent blood glucose measurements. Within several hours, the patient's blood sugars improved from over 600 to less than 200, so, per the protocol, his insulin infusion was decreased and the IV fluids were changed to D5 1/2 NS (hypotonic saline with added dextrose). That evening, the patient began to experience chest pain. An electrocardiogram (ECG) was performed and showed T-wave inversions in the lateral leads, prompting concern for cardiac ischemia. The cross-covering resident and attending saw the patient and decided to transfer him to the intensive care unit (ICU) for closer monitoring. The patient was made NPO (nothing by mouth) in case an urgent cardiac procedure was required. The resident therefore decided to discontinue the Glucommander, as he did not want the patient to experience dangerously low blood sugars. Orders were written for the patient to receive sliding scale subcutaneous insulin, and his IV fluids were changed to normal saline with no added dextrose. The patient's chest pain quickly resolved and he had no further ECG changes or evidence of cardiac ischemia. However, over the next several ho Continue reading >>

What Are The Med/surg Units Out There Doing In Regards To Iv Insulin Practice? Are There Any Restrictions On Iv Insulin Drips And Iv Bolus Push?

What Are The Med/surg Units Out There Doing In Regards To Iv Insulin Practice? Are There Any Restrictions On Iv Insulin Drips And Iv Bolus Push?

Complete Question: I need a response from group on administration of IV Insulin on med/surg units. What are the med/surg units out there doing in regards to IV insulin practice? Are there any restrictions on IV insulin drips and IV bolus push? Our hospital has IV insulin drips on IMCU and ICU, not med-surg, but we do give IV bolus on med-surg if needed. Answer: Upon investigation of your clinical question, members of the committee have provided their expertise in regards to IV Insulin administration on med-surg units. Upon querying multiple references, there is no specific standard that states that IV Insulin can or cannot be given on a med-surg unit, and that each organization can determine whether they will implement. Most of the members have stated that their organization only allows IV Insulin drips in their critical care units, mainly because of the constant and hourly monitoring of this specific medication. However, some organizations do allow IV Insulin to be administered on a med-surg unit, as long as strict guidelines and protocols are instituted and followed. References: (Published June 2015) About the AMSN Clinical Practice Committee (CPC) The CPC responds to questions clinical queries. The CPC members are clinical nurses, educators, faculty, and advanced practice nurses from across the country. We perform brief literature reviews and query our member hospitals to determine best practices in order to address your question. Continue reading >>

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