Hyperglycemia But Not DKA

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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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Ravi S. -

from July EMRAP-

"Should you give insulin IV or subcutaneously? Willis always
gives insulin IV because it works faster than subcutaneous insulin.
If insulin is administered subcutaneously, it has to diffuse
through the fatty tissue and some of our hyperglycemic patients
are obese".

I cannot find any support in the literature for the use of IV bolus Insulin for the situations outlines by Dr. Willis. Sub Q insulin will work fine for mild DKA (see below ref) and all the situations mentioned by Dr. Willis including non DKA hyperglycemia and Hyperosmolar states.

IV insulin is metabolized very quickly and also has the potential to cause sudden fluid and potassium shifts as was pointed out by Dr. Willis when he spoke of not giving insulin before the Potassium is known (and also never giving it if pt in DKA and hypotensive unless they have EKG changes of hyperkalemia)

September 1, 2004 THE AMERICAN JOURNAL OF MEDICINE Volume 117
Efficacy of Subcutaneous Insulin Lispro versus
Continuous Intravenous Regular Insulin for the
Treatment of Patients with Diabetic Ketoacidosis
Guillermo E. Umpierrez, MD, Kashif Latif, MD, James Stoever, MD, Ruben Cuervo, MD,
Linda Park, MD, Amado X. Freire, MD, MPH, Abbas E. Kitabchi, MD, PhD

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