insulin reaction


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dextrose

(dex-trose) ,

glucose

(trade name),

Glutose

(trade name),

Insta-glucose

(trade name),

Insulin Reaction

(trade name)

Classification

Therapeutic: caloric sources
Pharmacologic: carbohydrates
Pregnancy Category: C

Indications

Intravenous: Lower-concentration (2.5–11.5%) injection provides hydration and calories.Higher concentrations (up to 70%) treat hypoglycemia and in combination with amino acids provide calories for parenteral nutrition.50%—treatment of hypoglycemia (hyperinsulinemia or insulin shock). Oral: Corrects hypoglycemia in conscious patients.

Action

Provides calories.

Therapeutic effects

Provision of calories.
Prevention and treatment of hypoglycemia.

Pharmacokinetics

Absorption: Well absorbed following oral administration.
Distribution: Widely distributed and rapidly utilized.
Metabolism and Excretion: Metabolized to carbon dioxide and water. When renal threshold is exceeded, dextrose is excreted unchanged by the kidneys.
Half-life: Unknown.

Time/action profile (effects on blood sugar in diabetic patients)

ROUTEONSETPEAKDURATION
POrapidrapidbrief
IVrapidrapidbrief

Contraindications/Precautions

Contraindicated in: Allergy to corn or corn products; Hypertonic solution (>5%) should not be given to patients with CNS bleeding or anuria or who are at risk of dehydration.
Use Cautiously in: Known diabetic patients (frequent lab assessment necessary to quantitate appropriate doses); Neonates (excess/rapid infusion of solutions >10% may ↑ risk of intracerebral hemorrhage); Chronic alcoholics or severely malnourished patients (administration requires initial pretreatment with thiamine).

Adverse Reactions/Side Effects

Endocrinologic

  • inappropriate insulin secretion (long-term use)

Fluid and Electrolyte

  • fluid overload
  • hypokalemia
  • hypomagnesemia
  • hypophosphatemia

Local

  • local pain/irritation at IV site (hypertonic solution)

Metabolic

  • glycosuria
  • hyperglycemia

Interactions

Drug-Drug interaction

Will alter requirements for insulin or oral hypoglycemic agents in diabetic patients.

Route/Dosage

Hydration (as 5% solution)
Intravenous (Adults and Children) 0.5–0.8 g/kg/hr.
Hypoglycemia
Oral (Adults and Children) Conscious patients—10–20 g, may repeat in 10–20 min.
Intravenous (Adults) 20–50 mL of 50% solution infused slowly (3 mL/min).
Intravenous (Infants > 6 mo and Children) 0.5–1 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose).
Intravenous (Infants ≤ 6 mo and Neonates) 0.25–0.50 g/kg/dose (maximum of 25 g/dose) (as 25% dextrose);.

Availability (generic available)

Oral gel: 40% in 15-g, 30-g, and 45–g tubesOTC
Chewable tablets: 4 g, 5 gOTC
Solution for injection: 2.5%, 5%, 10%, 20%, 25%, 30%, 40%, 50%, 60%, 70%
In combination with: sodium chloride, other electrolytes, and amino acids.

Nursing implications

Nursing assessment

  • Assess the hydration status of patients receiving IV dextrose. Monitor intake and output and electrolyte concentrations. Assess patient for dehydration or edema.
  • Assess nutritional status, function of gastrointestinal tract, and caloric needs of patient.
  • Diabetic patients and patients receiving hypertonic dextrose solution (>5%) should have serum glucose, potassium, and phosphate monitored regularly.
  • Monitor IV site frequently for phlebitis and infection.
  • Lab Test Considerations: May cause an ↑ serum glucose level.

Potential Nursing Diagnoses

Deficient fluid volume (Indications)
Imbalanced nutrition: less than body requirements (Indications)
Excess fluid volume (Adverse Reactions)

Implementation

  • Dextrose solution alone does not contain enough calories to sustain an individual for a prolonged period. Dextrose contains 3.4 kcal/g. D5W contains 170 cal/liter and D10W contains 340 cal/liter.
  • Oral: Concentrated dextrose gels and chewable tablets may be used in the treatment of hypoglycemia in conscious patients. The dose should be repeated if symptoms persist and serum glucose has not increased by at least 20 mg/dL within 20 min. May be followed by more complex carbohydrates.
  • Intravenous: Hypertonic dextrose solution (>10%) should be administered IV into a central vein. For emergency treatment of hypoglycemia, administer slowly into a large peripheral vein to prevent phlebitis or sclerosis of the vein. Assess IV site frequently. Rapid infusions may cause hyperglycemia or fluid shifts. When hypertonic solution is discontinued, taper solution and administer D5W or D10W to prevent rebound hypoglycemia.
    • Patients requiring prolonged infusions of dextrose should have electrolytes added to the dextrose solution to prevent water intoxication and maintain fluid and electrolyte balance.
  • Additive Incompatibility: whole blood

Patient/Family Teaching

  • Explain the purpose of dextrose administration to patient.
  • Instruct diabetic patient on the correct method for self–blood glucose monitoring.
  • Advise patient on when and how to administer dextrose products for hypoglycemia.

Evaluation/Desired Outcomes

  • Correction and maintenance of adequate hydration status and normal serum glucose levels.
  • Maintenance of adequate caloric intake.

in·su·lin re·ac·tion

(insŭ-lin re-akshŭn)
Very low levels of blood sugar, which result from misdosage of insulin.
References in periodicals archive ?
Most individuals (n=28) reported needing an average of 40 minutes (M=39.68, SD=36.3) to recover their energy after experiencing an insulin reaction (three outliers were dropped from this analysis, due to their reporting of needing more than 24 hours to recover from an insulin reaction).
Individuals with diabetes were invited to participate and screened out of the research if they did not report verbally as having experienced an insulin reaction. As a secondary screening device, the questionnaire also included a question that asked participants to circle the physical signs that they experience during an insulin reaction.
Possibly the feeling of "being out of control" of one's body as a result of an insulin reaction is more often associated with non-adaptive, or at least psychologically distressing, feelings and less often related to the more adaptive states of acknowledgement and adjustment.
First, due to the potential danger of insulin reactions, rehabilitation professionals should make certain that their clients with diabetes know the early signs of an insulin reaction (which differ slightly among individuals) and know what to do when those signs occur.
First, the item content of the Responses to Insulin Reactions Survey (RIRS) is weighted toward asking individuals to respond to the difficulties that they experienced while having an insulin reaction.
Yet, the attempt to match non-diabetic blood-sugar levels (i.e., "tight control" by multiple injections of insulin each day) is often accompanied by a higher risk for insulin reactions. Several studies indicate that recurrent insulin reactions can cause permanent cognitive impairments in individuals with insulin-dependent diabetes (Langan, Deary, Hepburn, & Frier, 1991; Wredling, Levander, Adamson, & Lins, 1990), because brain cells die when deprived of glucose.
Because insulin reactions are the most frequent and potentially most dangerous side effect of insulin therapy, it is vital that you, your family and friends know how to recognize and treat it.
Insulin reactions can lead to high blood sugar levels (hyperglycemia) for hours after because the reaction releases stored glucose in the body which then combines with the sugar taken to counteract the insulin.
Beta-blockers have been shown to increase blood lipids and they may aggravate hyperglycemia or mask the patient's sympathetic response to an insulin reaction.
The patient must know the onset, peak and duration (see Table 3) of his/her insulin(s) to be able to understand: (1) which insulin contributes to basal insulin levels, (2) which insulin to adjust to coincide with plasma glucose excursions after a meal or snack, and (3) when each insulin is going to have its peak effect since this is the time when insulin reactions are most likely.
Signs, symptoms and treatment of hypoglycemia (insulin reactions)
* Give the sitter a brief `course' in diabetes so she can recognize the onset of an insulin reaction and know what to do about it.

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