bonovox

Coexist, or else...
10+ Year Member
Oct 10, 2004
8,058
9
251
In God's Country
Status
If you want to transition from insulin drip to SQ insulin in middle of night (no food available) since gap has closed and acidosis resolved, do you just go ahead and give basal dose, turn drip off an hour later, while keeping dextrose containing IV fluids on? Or do you just leave drip on until mealtime and transition then?
 

Bobblehead

Senior Member
15+ Year Member
Nov 30, 2003
693
90
371
Status
Attending Physician
It depends on whether you want to fill the ICU bed in the morning or afternoon with an admission.
 

jdh71

epiphany at nine thousand six hundred feet
10+ Year Member
Dec 14, 2006
67,360
45,200
281
FEMA Camp, USA
Status
Attending Physician
If you want to transition from insulin drip to SQ insulin in middle of night (no food available) since gap has closed and acidosis resolved, do you just go ahead and give basal dose, turn drip off an hour later, while keeping dextrose containing IV fluids on? Or do you just leave drip on until mealtime and transition then?
I like a 2 hour overlap, but that's probably more a matter of style and perhaps overly cuatious. But turn off the the D5. The nurses may give you a ton of crap, and that's usually when I print off the guidelines from uptodate and tell them to argue with the endocrine experts (dirty pool? yeah a little, but if your nurse feels comfortable doing it, she won't page you a hundred times an hour)

What I've found is since MOST nurses and residents prefer to deal with it during the day, it always get turned off when patients can eat not becuase it's necessary but becuase it's less hastle for everyone involved. So if you're bored one night and decide to micro-manage the DKA (which is cool, I think, because it can be done in a text-book recipe style fashion) and it comes time to overlap at ~3AM, the night nurses don't want to be bothered with it and they will complain. So it's not "wrong" per se to wait until breakfast, but it might save your some greif with the night staff.