Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

2019 ◽  
Vol 37 (1) ◽  
pp. 31-35
Author(s):  
Ahmed Aljabri ◽  
Stephen Perona ◽  
Mohannad Alshibani ◽  
Moteb Khobrani ◽  
Daniel Jarrell ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Regular Insulin ◽  
Blood Glucose Monitoring ◽  
High Incidence ◽  
Reduction Coefficient ◽  
Frequent Blood Glucose Monitoring ◽  
Glucose Reduction ◽  
Intravenous Dextrose

BackgroundDextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.MethodsThis was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.ResultsA total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).ConclusionsThe extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.

Fluid and Glucose

2021 ◽  
pp. 227-256
Keyword(s):  
At Risk ◽  
Blood Glucose ◽  
Glucose Monitoring ◽  
Oral Feeding ◽  
Blood Glucose Monitoring ◽  
Dextrose Solution ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Oral Doses ◽  
Intravenous Dextrose

The fluid and glucose chapter focuses primarily on unwell newborns who need early blood glucose monitoring for hypoglycemia and immediate stabilization with intravenous dextrose solution. But infants can be at risk for low blood glucose for many reasons, and they too need specific attention and care, even when they are not symptomatic. Oral doses of dextrose gel may help to raise blood glucose levels, which also depend on whether an infant cannot feed or should not be fed (for any reason) and response to supplementation or managed oral feeding. Guidance includes glucose thresholds to aim for, determined by postnatal age, and testing intervals to expedite the normalization of blood glucose values. How to assess, measure, and anticipate fluid requirements in at-risk infants is explained in detail, and risks for hypoglycaemia, dehydration, and overhydration are considered. Two case scenarios examine different hypoglycaemia risks.

scholarly journals A Rare Cause of Severe Hypoglycaemia

The Physician ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 1-5
Author(s):  
Laju Etchie ◽  
Devaka Fernando ◽  
Vakkat Muraleedharan ◽  
Ashok Poduval
Keyword(s):  
Blood Glucose ◽  
Severe Hypoglycaemia ◽  
Uterine Cancer ◽  
Glucose Monitoring ◽  
Oral Intake ◽  
Blood Glucose Monitoring ◽  
Hypoglycaemic Episode ◽  
Intravenous Glucose ◽  
Glucose Levels ◽  
Short Synacthen Test

A 67-year old woman presented with an unwitnessed fall and decreased oral intake. She had a learning disability, hypertension, epilepsy, asthma, chronic iron deficiency anaemia, mild lymphopenia, osteoporosis and treated uterine cancer. After clinical review, she was treated for Hospital-acquired pneumonia (following a recent hospital admission) with possible aspiration. She was noted to have hyponatraemia secondary to dehydration. She was commenced on intravenous Levofloxacin and Metronidazole along with supportive care, based on antibiotic guidance due to her known allergy to penicillin.On day 3 of admission, she was found unresponsive with a capillary blood glucose of 0.6 mmol/L, which improved with 10% glucose infusion. The low blood glucose was attributed to poor oral intake. However, her serial blood sugar results demonstrated persistent hypoglycaemia for 72h  needing further intravenous glucose infusions. A medication review was undertaken and Levofloxacin was discontinued. After 24hrs of discontinuation, the hypoglycaemic episode resolved. A short synacthen test showed a normal cortisol response. There were no further episodes of hypoglycaemia. Conclusion As her persistent hypoglycaemia resolved on discontinuation of Levofloxacin, a diagnosis of fluoroquinolone induced hypoglycaemia was reported to MHRA. Fluoroquinolones are thought to induce hypoglycaemia by increasing the insulin release via blockade of adenosine triphosphate-sensitive K+channels in the β cells of the pancreas. This effect may not be clinically evident in all patients because of physiologic mechanisms that regulate blood glucose levels. Health professionals should be aware of the potential risk of severe hypoglycaemia with the use of Fluoroquinolones which are a first or second-line treatment for common infective processes. Fluoroquinolones should be stopped immediately and switch to a non-Fluoroquinolones antibiotic if possible. In elderly patients with compromised oral intake or in those with other comorbidities, regular blood glucose monitoring should be carried out to avoid life-threatening hypoglycaemic episodes.  

Approach to Management

1990 ◽  
Vol 16 (5) ◽  
pp. 401-406 ◽  
Author(s):  
Diana W Guthrie ◽  
Richard A. Guthrie
Keyword(s):  
Blood Glucose ◽  
Patient Education ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Sliding Scale ◽  
Logic Approach ◽  
Catch Up ◽  
Frequent Blood Glucose Monitoring

This paper describes a physio logic approach to diabetes management called pattern therapy and compares it with the sliding scale or "catch-up" type of management. Pattern therapy differs from the sliding scale approach in that it anticipates rather than reflects insulin needs, and it relies heavily on intensive patient education and intelligent self-management. Frequent blood glucose monitoring is also a key aspect of pattern therapy.

941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 941-P
Author(s):  
LEI ZHANG ◽  
YAN GU ◽  
YUXIU YANG ◽  
NA WANG ◽  
WEIGUO GAO ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Cost ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Blood Glucose Monitoring
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