Why Is Dextrose Used With Insulin?

Why Give Glucose And Insulin For Hyperkalemia?

Hyperkalemia is a condition in which the levels of potassium in the bloodstream are abnormally high. There are many causes for hyperkalemia, mostly related to kidney disease because this organ helps control the levels of potassium in the body, and to hormonal causes. Administering glucose and insulin is one way to decrease the level of potassium in the bloodstream. Video of the Day Hyperkalemia usually results from acute or chronic kidney failure; from glomerulonephritis, in which the kidneys lose their ability to filter blood; and from rejection of a kidney transplant. According to Medline Plus, other causes include Addison’s disease, a condition in which the body fails to produce enough aldosterone, the hormone responsible for controlling the absorption of potassium from the kidneys; and from the use of diuretics, medicines used to regulate blood pressure by increasing the excretion of fluids and electrolytes in the urine. The symptoms of hyperkalemia may be mild at first, but severe hyperkalemia can cause arrhythmias, or dangerous abnormal heart rhythms, which can eventually cause the heart to stop beating. One of the reasons to give glucose and insulin to people with hyperkalemia is to decrease the chance of developing arrhythmias. Most potassium in the body resides inside the body’s cells, not in the bloodstream. Part of the treatment of hyperkalemia is driving potassium back into the cells. Insulin drives potassium into the cells by stimulating the uptake of the electrolyte by the cell membrane. This process begins within twenty to thirty minutes of the start of insulin treatment. Glucose is administered to facilitate this process and also to maintain glucose level in the bloodstream, as insulin can cause hypoglycemia, or low blood sugar. Other treatments for Continue reading >>

Glucose And Insulin Dynamics Associated With Continuous Infusion Of Dextrose Or Dextrose And Insulin In Healthy And Endotoxin-exposed Horses

JavaScript is disabled for your browser. Some features of this site may not work without it. Glucose and insulin dynamics associated with continuous infusion of dextrose or dextrose and insulin in healthy and endotoxin-exposed horses The objective of the study was to investigate and characterize the effects of a continuous rate infusion of dextrose or dextrose and insulin on glucose and insulin dynamics in both healthy and endotoxin-exposed horses. Administration of a low dose of endotoxin has been used in horses to mimic the clinicopathologic changes seen in endotoxemia, including the development of an inflammatory response. Our hypothesis was that a continuous rate infusion of insulin at a rate of 0.07 IU/kg/hr would prevent the development of hyperglycemia induced by administration of dextrose in both healthy and endotoxin-exposed horses. Nine healthy adult horses were used in the study. In Phase 1 of the experiment, horses received a saline infusion or a dextrose infusion in a balanced crossover design. In Phase 2 of the experiment, horses received a dextrose and insulin infusion, both prior to and after receiving a low dose of endotoxin (no LPS group and LPS group respectively) in a balanced crossover design. Blood samples were collected at regular intervals throughout both phases for measurement of plasma glucose and insulin concentrations. Infusion of dextrose alone resulted in hyperglycemia for nearly the entire study period. Insulin concentration was also increased in comparison to the saline infusion. When comparing the dextrose treatment group to the combined dextrose and insulin treatment group (no LPS group), the insulin levels were significantly greater over time in the latter group and resulted in maintenance of euglycemia. When comparing the no LPS grou Continue reading >>

Clinical Research Treatment Of Hyperkalemia With A Low-dose Insulin Protocol Is Effective And Results In Reduced Hypoglycemia

Complications associated with insulin treatment for hyperkalemia are serious and common. We hypothesize that, in chronic kidney disease (CKD) and end-stage renal disease (ESRD), giving 5 units instead of 10 units of i.v. regular insulin may reduce the risk of causing hypoglycemia when treating hyperkalemia. A retrospective quality improvement study on hyperkalemia management (K+ ≥ 6 mEq/l) from June 2013 through December 2013 was conducted at an urban emergency department center. Electronic medical records were reviewed, and data were extracted on presentation, management of hyperkalemia, incidence and timing of hypoglycemia, and whether treatment was ordered as a protocol through computerized physician order entry (CPOE). We evaluated whether an educational effort to encourage the use of a protocol through CPOE that suggests the use of 5 units might be beneficial for CKD/ESRD patients. A second audit of hyperkalemia management from July 2015 through January 2016 was conducted to assess the effects of intervention on hypoglycemia incidence. Treatments ordered using a protocol for hyperkalemia increased following the educational intervention (58 of 78 patients [74%] vs. 62 of 99 patients [62%]), and the number of CKD/ESRD patients prescribed 5 units of insulin as per protocol increased (30 of 32 patients [93%] vs. 32 of 43 [75%], P = .03). Associated with this, the incidence of hypoglycemia associated with insulin treatment was lower (7 of 63 patients [11%] vs. 22 of 76 patients [28%], P = .03), and there were no cases of severe hypoglycemia compared to the 3 cases before the intervention. Education on the use of a protocol for hyperkalemia resulted in a reduction in the number of patients with severe hypoglycemia associated with insulin treatment. Figure 2. Outline of Continue reading >>

Dextrose - Side Effects, Dosage, Interactions - Drugs - Everyday Health

Glucose is a form of natural sugar that is normally produced by the liver. Glucose is a source of energy, and all the cells and organs in your body need glucose to function properly. Glucose as a medication is given either by mouth (orally) or by injection. Glucose is used to treat very low blood sugar (hypoglycemia), most often in people with diabetes mellitus. Glucose is given by injection to treat insulin shock (low blood sugar caused by using insulin and then not eating a meal or eating enough food afterward). This medicine works by quickly increasing the amount of glucose in your blood. Glucose is also used to provide carbohydrate calories to a person who cannot eat because of illness, trauma, or other medical condition. Glucose is sometimes given to people who are sick from drinking too much alcohol. Glucose may also be used to treat hyperkalemia (high levels of potassium in your blood). Glucose may also be used for purposes not listed in this medication guide. Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. You should not take glucose tablets, liquid, or gel if you are allergic to any of the ingredients in these forms of the medicine. If possible before you receive a glucose injection, tell your doctor if you have: diabetes (unless you are using this medicine to treat insulin-induced hypoglycemia); heart disease, coronary artery disease, or history of a stroke; Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers or call your doctor right away if you have: redness, swelling, warmth, or skin changes where an injection was given; a Continue reading >>

Hyperkalemia Management: Preventing Hypoglycemia From Insulin

Insulin remains one of the cornerstones of early severe hyperkalemia management. Insulin works via a complex process to temporarily shift potassium intracellularly. Though insulin certainly lowers plasma potassium concentrations, we often underestimate the hypoglycemic potential of a 10 unit IV insulin dose in this setting. The purpose of this post is to highlight the need for proper supplemental glucose and blood glucose monitoring when treating hyperkalemia with insulin. Incidence of Hypoglycemia One of my favorite articles on the management of hyperkalemia was written by Dr. Weisberg in Critical Care Medicine.1 A 10 unit dose of IV regular insulin has an onset of action of about 5-10 minutes, peaks at 25-30 minutes, and lasts 2-3 hours (the Weisberg article actually lists subcutaneous kinetics). Herein lies the problem in that IV dextrose only lasts about an hour (at most). Allon et al reported up to 75% of hemodialysis patients with hyperkalemia developed hypoglycemia at 60 minutes after insulin administration.2 A retrospective review of 219 hyperkalemic patients reported an 8.7% incidence of hypoglycemia after insulin treatment.3 More than half of the hypoglycemic episodes occurred with the commonly used regimen of 10 units of IV insulin with 25 gm of dextrose. A more recent study of 221 end-stage renal disease patients who received insulin for treatment of hyperkalemia reported a 13% incidence of hypoglycemia.4 The overall incidence of hypoglycemia appears to be ~10%, but could be higher. Risk Factors for Developing Hypoglycemia The study by Apel et al identified three factors associated with a higher risk of developing hypoglycemia: No prior diagnosis of diabetes [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.0–5.1, P = 0.05] No use of diabetes medication Continue reading >>

Dextrose 5% In Water (d5w)

Dextrose is a form of glucose (sugar). Dextrose 5% in water is injected into a vein through an IV to replace lost fluids and provide carbohydrates to the body. Dextrose 5% in water is used to treat low blood sugar (hypoglycemia), insulin shock, or dehydration (fluid loss). Dextrose 5% in water is also given for nutritional support to patients who are unable to eat because of illness, injury, or other medical condition. Dextrose 5% in water is sometimes used as a diluent (liquid) for preparing injectable medication in an IV bag. A diluent provides a large amount of fluid in which to dilute a small amount of medicine. The diluent helps carry the medicine into your bloodstream through the IV. This helps your caregivers inject the medicine slowly and more safely into your body. Dextrose 5% in water may also be used for purposes not listed in this medication guide. You should not use this medication if you are allergic to dextrose. Before using dextrose 5% in water, tell your doctor if you have diabetes, breathing problems, an electrolyte imbalance, kidney or liver disease, a food or drug allergy, or if you receive regular blood transfusions. Do not mix dextrose 5% in water with any medication that has not been prescribed by your doctor. If you are using the injections at home, be sure you understand how to properly mix and store your medicine. Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when dextrose 5% in water is injected. Stop using dextrose 5% in water and call your doctor at once if you have a fever, cough, wheezing, increased thirst or urination, confusion, hallucinations, extreme thirst, muscle weakness, weak or shallow breathing, fainting, or severe irritation or signs of infection around the IV needle. You should not use th Continue reading >>

Insulin

insulin [in´su-lin] 1. the major fuel-regulating hormone of the body, a double-chain protein formed from proinsulin in the beta cells of the islets of Langerhans in the pancreas. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis. Secretion of insulin is a response of the beta cells to a stimulus; the primary stimulus is glucose, and others are amino acids and hormones such as secretin, pancreozymin, and gastrin. These chemicals play an important role in maintaining normal blood glucose levels by triggering insulin release after a meal. After insulin is released from the beta cells, it enters the blood stream and is transported to cells throughout the body. The cell membranes have insulin receptors to which the hormone becomes bonded or “fixed.” An interaction between the insulin and its receptors leads to biochemical processes that include (1) the transport of glucose, amino acids, and certain ions across the membrane and into the cell body; (2) the storage of glycogen in liver and muscle cells; (3) the synthesis of triglycerides and storage of fat; (4) the synthesis of protein, RNA, and DNA, and (5) inhibition of gluconeogenesis, degradation of glycogen and protein, and lipolysis. Although insulin increases the transport of glucose across the cell membrane of most cells, in the brain glucose enters the cells by simple diffusion through the blood--brain barrier. 2. a preparation of the hormone, first discovered in 1921, used in treatment of diabetes mellitus; it may be bovine or porcine in origin (prepared from the pancreas of the animals) or a recombinant human type, although insulin of bovine origin is no longer available in the United States. Recombinant human Continue reading >>

Insulin And Glucose In The Treatment Of Hyperkalaemia - General Practice Notebook

insulin and glucose in the treatment of hyperkalaemia 10u of soluble insulin (eg actrapid) with 50mls of 50% glucose (ie 25g) given over 15 minutes. Insulin stimulates the Na+-K+ ATPase pump in skeletal muscle, cardiac muscle and liver so driving potassium into cells. Serum potassium concentration is therefore lowered. Simultaneous administration of glucose is necessary in order to prevent hypoglycaemia. Effects should be apparent within 30-60 minutes and should last for 4-6 hours. Insulin produces only a temporary reduction in serum potassium. It does not remove K+ from the body. It may be necessary to repeat administration or continue infusion at a ratio of 3-4g of glucose to each unit of insulin. Titrate against serum potassium and glucose. In children an insulin infusion may be used, starting at approximately 0.05 units of insulin per kilogram body weight per hour, usually made up as 50 units of fast acting insulin in 50 ml of normal saline. Note that it is mandatory under these circumstances to also have a glucose infusion running, and to keep a very close eye on the blood sugar level. Continue reading >>

Diabetic Hypoglycemia

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an estimated 55,819 cases (8.0% of total admissions) involved insulin, and severe hypoglycemia is likely the single most common event.[1] In general, hypoglycemia occurs when a treatment to lower the elevated blood glucose of diabetes inaccurately matches the body's physiological need, and therefore causes the glucose to fall to a below-normal level. Definition[edit] A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl (3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can sometimes occur at higher glucose levels, or may fail to occur at lower. Some textbooks for nursing and pre-hospital care use the range 80 mg/dl to 120 mg/dl (4.4 mmol/l to 6.7 mmol/l). This variability is further compounded by the imprecision of glucose meter measurements at low levels, or the ability of glucose levels to change rapidly. Signs and symptoms[edit] Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it". A co-morbidity is the issue of hypoglycemia unawareness. Recent research using machine learning methods have proved to Continue reading >>

$Pulmcrit – Treatment Of Massive Insulin Poisoning Refractory To Glucose$

Pulmcrit – Treatment Of Massive Insulin Poisoning Refractory To Glucose

Introduction with two cases Case #1 The first case of steroid use for refractory hypoglycemia at Genius General occurred several years ago. A patient developed numerous episodes of hypoglycemia requiring large volumes of IV dextrose. In efforts to avoid recurrent hypoglycemia, 125 mg IV methylprednisolone was given. Hypoglycemia resolved immediately, but the patient subsequently developed moderate hyperglycemia in the 300-400 mg/dL range (without diabetic ketoacidosis). The patient did fine clinically. However, this case suggested that steroid with a shorter half-life (e.g. IV hydrocortisone) might be preferable to facilitate titration and avoid prolonged hyperglycemia. Case #2 A 60-year-old woman with type-II diabetes was brought to the hospital following a suicide attempt with glargine insulin. Before arrival, the patient was conscious and treated with oral carbohydrate. Initially she received aggressive IV dextrose (several ampules of D50W plus an infusion of D10W at 200 ml/hr). However, her glucose remained below 30 mg/dL. Fortunately, she remained only mildly symptomatic with a glucose in the 20-30 mg/dL range (perhaps due to adequate intracellular glucose). Based on the failure of IV dextrose, 100 mg IV hydrocortisone Q6hr was initiated. Immediately after starting steroid, her glucose rose to a safe level. The D10W infusion was reduced from 200 ml/hr to 100 ml/hr. Over the next two days, steroid and D10W infusions were gradually weaned off. Her recovery was unremarkable, without recurrence of hypoglycemia. She did receive one dose of IV glucagon along with the first dose of hydrocortisone. This could muddy the waters a bit. However, given the short duration of glucagon (typically lasting 15-20 minutes), it is extremely doubtful that a single dose could explain her Continue reading >>

Need Help Understanding An Insulin Drip

Can anyone explain WHY we give D10W with an insulin drip? I am trying to understand the relationship and the pathophysiology of this. Thanks! Specialty:9 year(s) of experienceinER, CVICU, Rapid Response I think I need more info. Was the patient admitted with DKA? No, just standard Endotool for a post-op pt. that isn't NPO. I understand that they need some form of sugar, but if we are trying to keep tight parameters on their blood glucose post-op, why would we give dextrose on top of the insulin? The orders read, continue D10W @ 30mL/hr if BG < 180 and continue Endotool. Thanks! Well, everybody's Insulin protocol is different, and every surgeon has their own preferences. If the patient was a fresh post-op, then perhaps they just wanted to make sure they didn't bottom out from the drip. Look closely at the patient's history, that might give you some clues. Lacking more information to answer your question.... I think sometimes you hang D10W with insulin drip so the pt won't go hypoglycemic. Not 100% sure but I think I heard something along those lines once lol. I'm not an RN, nor am I familiar with the Endotool... but I think I've got a handle on this. A quick review of this topic and my own knowledge of insulin/glucose leads me to exactly the same conclusion - it's precisely to keep the patient from going hypoglycemic. As the Endotool is a computerized insulin therapy system that adapts to a patient's blood glucose levels, it isn't able to instantly stop insulin that's already in the body from continuing to work if glucose levels suddenly drop off and there's no glucose source available to bring the level back up. I imagine that the system is certainly capable of controlling insulin infusion rates, so there's either a steady-state D5 or D10 infusion going OR the system c Continue reading >>

Diabetic Emergencies, Diabetic Ketoacidosis In Adults, Part 3

Clinical Management Treatment consists of rehydration with intravenous fluids, the administration of insulin, and replacement of electrolytes. General medical care and close supervision by trained medical and nursing staff is of paramount importance in the management of patients with DKA. A treatment flowchart (Table 1.3) should be used and updated meticulously. A urine catheter is necessary if the patient is in coma or if no urine is passed in the first 4 hours…. Replacement of water deficit Patients with DKA have severe dehydration. The amount of fluid needing to be administered depends on the degree of dehydration (Table 1.4). Fluid replacement aims at correction of the volume deficit and not to restore serum osmolality to normal. Isotonic solution NaCl (0.9%) (normal saline; osmolality 308 mOsm/kg) should be administered even in patients with high serum osmolality since this solution is hypotonic compared to the extracellular fluid of the patient. 10 The initial rate of fluid administration depends on the degree of volume depletion and underlying cardiac and renal function. In a young adult with normal cardiac and/or renal function 1 L of normal saline is administered intravenously within the first half- to one hour. In the second hour administer another 1 L, and between the third and the fifth hours administer 0.5–1 L per hour. Thus, the total volume in the first 5 hours should be 3.5–5 L [1]. If the patient is in shock or blood pressure does not respond to normal saline infusion, colloid solutions together with normal saline may be used.1,6 Some authors suggest replacement of normal saline with hypotonic (0.45%) saline solution after stabilization of the hemodynamic status of the patient and when corrected serum sodium levels are normal.8 However, this appro Continue reading >>

Mixed Results For Insulin/dextrose Infusion Therapy

Mixed results for insulin/dextrose infusion therapy In patients who had an acute myocardial infarction, treatment with insulin/dextrose infusion therapy did not significantly lower mortality risk. Insulin/dextrose infusion therapy does not appear to offer a reduction in mortality risk in patients who recently had an acute myocardial infarction, according to a study by Australian researchers. , was designed to examine whether improved glycemic control achieved through insulin/dextrose infusion therapy with a variable rate of insulin would help to reduce mortality in patients with hyperglycemia following an acute myocardial infarction. Previous studies have shown conflicting results regarding the benefits of various intravenous insulin therapies on this patient population. N. Wah Cheung, PhD, from the center for diabetes and endocrinology research at Westmead Hospital in Westmead, Australia, one of the studys researchers, told that the reduction in mortality among patients who were treated with insulin/dextrose infusion therapy was not as significant as the researchers were hoping. The major problem we had in our study was that the patients who were randomized to insulin infusion did not have their blood glucose levels driven down low enough, Cheung said. This was possibly because of undue concern regarding the possibility of hypoglycemia amongst the nursing staff, and therefore aggressive titration of insulin was not maintained. The researchers examined 240 patients who had had an acute myocardial infarction for this study. Patients eligible for the study had either diagnosed diabetes or did not have diabetes but had blood glucose levels >140.4 mg/dL. Patients were randomly divided into two groups. The first group received insulin/dextrose infusion therapy for at least Continue reading >>

Inpatient Glycemic Control

What is Guiding our Nutrition Therapy Need for standardized Carbohydrate intake at meal Knowledge of carbohydrate content of Tube feedings Managing carbohydrate infusion via TPN All of the above to be based on an appropriate nutritional assessment Research Studies Rush University Guidelines, Nov.2006 The Diabetes Educator 32(6):954-962. Nov/Dec 2006. ASPEN Nutrition Support Practice Manual 2nd edition, 2005. McMahon M Mayo Clinic Nutrition in Clinical Practice 19:120-128. April 2004. Research Grainger A, Eiden K, Kemper J, Reeds D Nutrition in Clinical Practice 22:545-552. Oct 2007. Clement S et al: 2004 Diabetes Care 27:553-591. Feb 2004. Leahy J. Endocrine Practice, 12(13):86-90. July/August 2006. ACE/ADA Inpatient Diabetes and Glycemic Control Consensus Conference Insulin Requirements in Health and Illness Copyright Â© 2004 American Diabetes Association. From Clement S, et al. Diabetes Care. 2004;27:553â€“591. Reprinted with permission. Units Healthy Sick/Eating Sick/NPO Correction Nutritional Prandial Basal Insulin Requirements in Health and Illness Components of insulin requirements are defined physiologically and are divided into basal, prandial (mealtime) or nutritional, and correction insulin. Insulin required to cover â€œnutritionalâ€ needs may include insulin needed to cover intravenous dextrose, total parenteral nutrition, enteral feedings, and nutritional supplements. The basal and prandial/nutritional orders as written as scheduled insulin while correction dose insulin tends to be written as an algorithm to supplement scheduled insulin. Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in the hospital. Diabetes Care. 2004;27:553â€“591. Elements of Carbohydrate (CHO) Counting for RN Education Carbohydrate Continue reading >>

Insulin For The Treatment Of Hyperkalemia: A Double-edged Sword?

Potassium plays a critical role in cellular metabolism and normal neuromuscular function. Tightly regulated homeostatic mechanisms have developed in the process of evolution to provide primary defense against the threats of hyper- and hypokalemia. The kidney plays a primary role in potassium balance, by increasing or decreasing the rate of potassium excretion. Distribution of potassium between the intracellular and the extracellular fluid compartments is regulated by physiologic factors such as insulin and catecholamines which stimulate the activity of the Na+-K+ ATPase. Only about 10% of the ingested potassium is excreted via the gut under normal physiologic conditions [1]. End stage renal disease (ESRD) patients rely largely on extra-renal mechanisms and dialysis to maintain potassium homeostasis. Despite the availability of dialysis and the adaptive increase in colonic excretion of potassium in renal insufficiency, severe hyperkalemia (defined as serum potassium level > 6 mEq/L [6 mmol/L]) is observed in 5-10% of maintenance dialysis patients and is responsible for 0.7% of deaths in the dialysis population in the United States [2–4]. Several factors can explain the high incidence of hyperkalemia in this population. Tolerance for a rapid potassium load is impaired in ESRD, not only because of lack of renal excretion, but also as a result of impaired cellular distribution of potassium [5]. The latter may result from defect in the Na+-K+ ATPase and possibly elevated glucagon levels in uremia [5, 6]. High dietary potassium intake and missed dialysis treatments are common contributors to hyperkalemia in ESRD patients. Other factors such as constipation (decreased colonic excretion) and fasting state (relative lack of insulin) may also predispose ESRD patients to hyperka Continue reading >>