You work as an internist too? nice!
I’m assuming you are referring to the appy or perfed bowel that took their meds this morning? Just put em on a dextrose ggt and admit em.
Well if insulin dependent( though that is archaic nomenclature ) , ie dm1, then that is a sure way to put them in dka…sliding scale is rarely the correct regimen for diabetes pts, and never the correct regimen for a type 1.
Hah was waiting for this.
Why would a type 1 be on a SU?
Sometimes it's all you can do. Patient has bad insurance and absolutely refuses insulin is when I typically use them.
Octreotide 50 mcg IV or SQ generally fixes that. Likely will still needs the unit for a hour bgl checks though.
was just gonna recommend this - I haven't seen it used a lot, but after a pt gets repeated D50 bolus and keeps tanking, a dose of octreotide seems to stabilize them
Part of the problem might be D50. D50 has some evidence that it causes paradoxical hypoglycemia since the body is suddenly getting a large glucose load and over reacts. There's a growing body of evidence that a 250 ml bolus of D10 is just as efficacious, safer, and has less rebound hypoglycemia.
pubmed.ncbi.nlm.nih.gov
www.aliem.com
with our D50 shortage, we have been moving to this now - EMS has been doing this around us for a few years. Will have to dig into the data and see if we want to make a permanent change when the shortage resolves.Part of the problem might be D50. D50 has some evidence that it causes paradoxical hypoglycemia since the body is suddenly getting a large glucose load and over reacts. There's a growing body of evidence that a 250 ml bolus of D10 is just as efficacious, safer, and has less rebound hypoglycemia.
A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting - PubMed
When comparing D10 with D50 for the treatment of hypoglycemia by EMS, there were no significant differences in the need for dextrose retreatment prior to hospital arrival. The use of D50 resulted in a significantly higher blood glucose concentrations both in the prehospital setting and upon...D10 May Be Better Than D50 For Acute Hypoglycemia | Emergency Physicians Monthly
Emergency physicians should consider switching from D50W to the safer, less error-prone, equally effective D10W when treating hypoglycemia. “An amp of D50” – 25 grams of glucose in a 50 mlprefilled syringe (50% glucose) – is, and has been since at least the middle of the last century, a standard...epmonthly.com
D50 vs D10 for Severe Hypoglycemia in the Emergency Department
D50 vs D10 for Severe Hypoglycemia in the Emergency Department
We switched to D10 about 5 years ago at the fire department where I'm medical director.Part of the problem might be D50. D50 has some evidence that it causes paradoxical hypoglycemia since the body is suddenly getting a large glucose load and over reacts. There's a growing body of evidence that a 250 ml bolus of D10 is just as efficacious, safer, and has less rebound hypoglycemia.
A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting - PubMed
When comparing D10 with D50 for the treatment of hypoglycemia by EMS, there were no significant differences in the need for dextrose retreatment prior to hospital arrival. The use of D50 resulted in a significantly higher blood glucose concentrations both in the prehospital setting and upon...D10 May Be Better Than D50 For Acute Hypoglycemia | Emergency Physicians Monthly
Emergency physicians should consider switching from D50W to the safer, less error-prone, equally effective D10W when treating hypoglycemia. “An amp of D50” – 25 grams of glucose in a 50 mlprefilled syringe (50% glucose) – is, and has been since at least the middle of the last century, a standard...D50 vs D10 for Severe Hypoglycemia in the Emergency Department
D50 vs D10 for Severe Hypoglycemia in the Emergency Department
Lol more like 2-3/week for me.
my excuse is I am a nerd pharmacist that teaches toxicology to students and pharm residents - haha
Pretty sure that it’s just the trade name for the generic drug.
Ya. Sandostatin is just the brand name for octreotide. There is a depot version. Sandostatin LAR
It’s a common board prep question
The other day house supervisor wanted a GI bleed on octreotide to go to icu. I said no this is about the most stable patient in the dept.. melena for a week, hgb 10, normal VS. he said to Titrate the octreotide. Im like … it’s a set dose .. no titration.. finally my charge nurse determined supervisor was worried because he didn’t know what octreotide was, and when I said the magic word (Sandostatin) I got my tele bed. Lol
Sorry… 2different vents…
Lol… no that’s the abbreviation for sliding scale insulin… which even that isn’t accurate… what is used in the hospitals is really a correction scale since it usually starts at a bg of 150… had an attending in fellowship that would had out a 2 page article on the difference between sliding scale and correction scale to anyone that said sliding scale during rounds…
Fsbg 500+? 20U of SQ humalog. Ivf. Recheck in an hour or two. DC.
Assuming no DKA or altered loc, is there a glucose number that would make you rethink your strategy?
I don't really have a hard and fast rule. I suppose if I had a patient with a glucose of 1000, I'd consider admitting them. That said, if they were completely asymptomatic from a neuro POV and not in DKA and had ZERO other issues, I'd likely put them on a relatively high dose insulin gtt in the ED + 10meq K/hr and then DC them after I got it down to a sane number. From a flow point of view, that approach is definitely faster these days than trying to admit them anyway. We got no beds.
Why IV?
My definition of massive insulin use is closer to 500 units a day…basal 100 units and mealtime 40 units…eh…
