It is often encountered in clinical situations: diabetic patients need to use 5% glucose in the treatment 250 ml of injection solution is used as a diluent (infusion vehicle) for the treatment drug, what should I do?
Experienced seniors answer: At the same time, add 4 U of insulin for redemption.
So, is this medication the right way?
- Why not choose an infusion other than glucose as a vehicle?
- If a patient is taking oral hypoglycemic drugs, do they still need to continue taking it?
Why do I have to use glucose?
If you want to know the answer to these questions, you must first understand how the drug vehicle is selected in clinical treatment. Usually we choose the vehicle according to the stability of the drug after dissolution and the contraindication of the patient’s disease. For example, patients with cardiovascular disease and high blood pressure need to control sodium intake. Some therapeutic drugs are only suitable for dissolving with glucose injection. In some cases, adding insulin to glucose infusion is necessary for treatment. For example, the composition of insulin, glucose and potassium chloride (GIK) has the effect of stabilizing the cell membrane, which is clinically called polarizing fluid. It can correct intracellular potassium deficiency, provide energy, reduce free fatty acids in ischemic myocardium, and be used to prevent and treat arrhythmias during myocardial infarction.
Can diabetics use glucose?
But what you need to know is that people with diabetes are not completely incapable of using glucose, they just can’t consume it in excess. We can do an arithmetic problem: a normal adult diet, 100 g of rice (converted to sugar at 75%) is about 75 g of glucose, and a 250 ml bottle of 5% glucose injection, The sugar content is only 12.5 g. Therefore, diabetic patients do not need to be too concerned about the use of glucose injection, but only need to pay attention to glucose intake and blood sugar changes while taking medication.
How should insulin be dispensed?
If diabetic patients have to use glucose injection as a vehicle, without changing the routine treatment and diet of diabetic patients, they will generally use insulin dui Chong infusion in clinical practice. of glucose. Generally, the ratio of glucose to insulin is about 5:1. The normal usage is to add 5 U of insulin to a 500 ml bottle of 5% glucose injection. However, each patient responds differently to the drug, and individualized medication is still required. Therefore, it is best to first determine the patient’s current blood sugar level, and then adjust the insulin dose required for redemption on a basis. The general principle is: when the blood sugar is high, the insulin dosage is slightly increased when the sugar water is dripped, and the insulin is reduced when the blood sugar is low. 1. For diabetic patients whose fasting blood glucose is below 13.9 mmol/L, the ratio of glucose: insulin = 3:1 should be used, for example: 5% GS 250 mL+ RI (regular insulin) 4 units, 500 mL with 8 units of insulin;2. If the fasting blood glucose is higher than 13.9 mmol/L, the insulin dosage will be increased accordingly, and the ratio can be up to 2:1; 3. If the blood glucose level If it is very high, you need to use NS + insulin to lower the blood sugar first. 4. For patients who have never used insulin (including subcutaneous and intravenous), the addition of insulin to the first vial of glucose (blood glucose > 13.9 mmol/L available saline) should be conservative. Usually 4 g of sugar plus 1 U of insulin, blood sugar is measured every hour, and the drip rate or insulin dose is adjusted according to the blood sugar level.
Relationship between insulin and other drugs
Because insulin is a polypeptide structure, it is easy to accept Due to the influence of factors, there are incompatibility with many drugs, so do not advocate mixed infusion with other drugs; and the material of the infusion bottle may cause adsorption of insulin, and the actual amount of insulin entering the human body will be reduced. For diabetic patients, in order to avoid excessive intake of glucose, non-glucose infusions such as fructose and xylitol can be selected as vehicles. However, because this type of infusion is expensive and has incompatibility with many drugs, it is not a solvent routinely recommended by drug instructions. In addition, it should be noted that the metabolites of glucose are carbon dioxide and water, and the metabolites of fructose are lactic acid. Excessive use may cause life-threatening lactic acidosis, so it is not suitable for parenteral use. Energy supply in nutrition.
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