IV Insulin
How long can you hang a bag of insulin for?
what is 24 hours
An acute major life threatening complication of diabetes characterized by hyperglycemia, with metabolic acidosis and an increasing anion gap.
Indications of DKA:
Blood glucose of greater than 11 mmol/L*
Bicarbonate of less than 18 mmol/L.
Anion Gap of greater that 12 mmol/L.
The anion gap measures the difference—or gap—between the negatively charged and positively charged electrolytes in your blood.
Ketone screen positive.
pH of 7.3 or less.
What is diabetic ketoacidosis
What protocol is initiated when your blood sugar is less than 4mmol/L
Bonus: What are the parameters for mild-moderate and severe blood sugars
What is he hypoglycemia initial emergency treatment (adult) decision support tool
Bonus: mild to moderate 2.8-3.9
severe: <2.9
In this condition the body cannot properly use the insulin it makes
What is Type 2 - The body cannot properly use the insulin it makes
As a result blood sugar is higher than normal.
Do you need a Doctors order for a DNE referral?
Bonus: how do you do a DNE referral?
No
Bonus: Phone the phone number on the GAL and leave a detailed message
Where will you find our unit stock pre mixed insulin bags
Where is in the medication fridge
Phase 1 - Initial 3 bag infusion
Phase 2 - transition to subcutaneous insulin
What are the two phases of DKA treatment
Dysphagic patient who is able to swallow has a blood sugar of 2.0
Using the hypoglycemic protocol what should we admin?
what is give 20 g fast-acting carbohydrate
e.g. for dysphagic patients 2 packages of honey or 1 tube of glucose gel
You know your diabetic patient is doing well when their blood sugar is within this range.
what is between 4-7 mmol/
Increased thirst, Nausea/Vomiting, Abdominal Pain, Confusion are symptoms of what medical emergency?
What is Diabetic Ketoacidosis
What do you do if the rate needs to be decreased to less than 0.5 unit/h
Stop infusion
Recheck bedside blood glucose Q2H
Once blood glucose is 6mmol/L or greater resume insulin infusion at previous rate or at 1 unit/h, whichever is lower
These three infusions are used in phase 1 of DKA
What are
1. Crystalloid fluid - to restore fluids
2. Insulin - to treat the acidosis
3. Dextrose (D10W) - to prevent hypoglycemia
Patient is NPO and has pulled out their enteral tube and IV and their OT is 2.9
You may attempt to insert an IV for no more than 2 mins and give IV dextrose 50% 12.5g/25ml (1/2 a pre-filled syringe)
OR
give glucagon 3 mg intranasal (1push/dose)
**glucagon may cause vomiting**
OR
1mg glucagon IM/SC (1 unit dose syringe)
This lab value measures how much glucose has adhered to RBCs and the average blood glucose for the previous 3 months
What is A1C
What body part of your diabetic patient is important to assess in your head to toe?
What is check their feet.
Diabetic patients are at a high risk of feet infections/amputations. Always take off their socks!
What do you do with IV insulin if patients TPN or tube feed has stopped for greater than 1 hour
Notify MRP ordering insulin for further orders
When do we start the insulin infusion
when K+ is greater than 3.3
Patient is NPO and on TPN with a blood sugar of 1.9 and have IV access.
What do we give?
When do we check the next BG?
give IV dextrose 50% 12.5g/25ml (1/2 a pre-filled syringe) X2
Re check in 15 mins
Bonus:
Next BG is 2.3
Check BG again and BG is 2.9
Notify MRP urgently
Why does med safety suggest we do not share insulin pens among patients
What is due to the risk of back flow of blood into the pen, during injection
These are 3 preferred areas to teach a patient to self inject insulin
What are abdomen, thigh, buttocks
What should you do if you are betting blood back into the IV during the insulin infusion
Phone MRP and receive and order for a driver fluid
Connect to the Y site as close to the patient as possible
Ensure drive fluid is compatible with insulin
Required rate depends on vessel size, IV gauge, etc. recommended rate is 10-20ml//hr
You'll know when acidosis is resolved when?
What is anion gap is less than 11mmol/L and bicarbonate is greater than 18 mmol/L
Patient has an established Tube feed with blood glucose 3.0
What do you give them?
Bonus: BG 6.2 after 15min
The next tube feed is more than an hour away. What should you do now?
Give 15G of fast acting carbohydrate
Admin 150-170mls apple juice and flush with water pre/post
Bonus: Discuss with MRP
This is device allows patients to monitor blood glucose levels and independently admin continuous subcutaneous insulin infusions.
Bonus: What do these patients need when they're a patient in the hospital?
What is an insulin pump
Bonus: Insulin pump order set
Patient or caregiver eligibility criteria
patient handout to self-manage insulin
insulin and glucose log sheet
Lipohypertrophy (raised, red, hard areas on the skin) can be avoided by doing this when injecting insulin
What is rotating injection sites