“She has diabetes, why is she still losing glucose?” the nurse was dumbfounded! This question must be known

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Introduction
diabetics, also Can I infuse glucose solution? 
Due to the absolute or relative lack of insulin in the body, diabetic patients cannot effectively metabolize and utilize glucose, resulting in elevated blood sugar. Can diabetic patients still be infused with glucose solution? Look at the following content~“Nurse, nurse, come and have a look, my mother has diabetes, why do you still use glucose for her? What should I do if you use this medicine to make my mother’s diabetes worse?”Faced with such a question, if you are a “new nurse”, are you Feeling guilty? Is it right for such patients to use glucose if they think they have followed the wrong doctor’s orders? Case reviewAn elderly woman, 67 years old, with a history of diabetes 20 years, admission diagnosis: type II diabetes, diabetic coronary heart disease, arrhythmia, atrial fibrillation, hypertension.  At the time of admission, the patient was conscious and in poor spirit, blood pressure 166/90mmHg, random blood glucose 18.6mmol/L; bedside electrocardiogram: atrial fibrillation, II, III, aVF , V6 lead ST segment depression; myocardial four items: N-terminal brain natriuretic peptide 2008.00pg/ml. After admission, first-level nursing care, low-salt and low-fat diet, blood pressure measurement, ECG monitoring, continuous oxygen inhalation, and input and output are given; cardiotonic, diuretic, cardiac load reduction, cardiac function improvement and other drug treatments . View the patient’s doctor’s order:“10% glucose 500ml+10% potassium chloride+10% magnesium sulfate 10ml+ regular insulin 10u ivdrip Qd”. Check the doctor’s order again, combined with the patient’s medical record, If you were the responsible nurse, would you implement it? Is this doctor’s order correct? As an “old nurse”, I checked the doctor’s order and determined that the doctor’s order was fine. This is not “extreme” Chemical liquid” well! Symptomatic, there is nothing wrong with it! In medical terms, it is called “magnesium polarizing solution (sugar+insulin+potassium chloride+magnesium sulfate)“. Why polar fluids? Polarized fluid (GIK) therapy is one of the common methods for the treatment of coronary heart disease. At the same time, polarized liquid can act on multiple pathophysiological links of cerebral ischemia injury, and it is a good brain protective agent. For patients with diabetes complicated with acute cerebral infarction, especially those with high blood sugar, the early application of polarized liquid for treatment is very important. benefit. So what is polaroid therapy? The polarizing fluid is a liquid composed of glucose, insulin, and potassium chloride. It can promote myocardial uptake and metabolism of glucose, so that potassium ions can enter the cell to restore the polarization state of the cell membrane. Conducive to the normal contraction of the heart and reduce arrhythmia. Insulin and K+ in the polarizing fluid can act together on Na+-K+-ATPase, increase the activity of the enzyme, promote Na+ excretion and K+ entry into cells, reduce sodium and water retention, and K+ can balance The potential on both sides of the cell membrane stabilizes the cell membrane and prevents cell necrosis. A certain amount of magnesium sulfate is added to the conventional polarizing solution because magnesium has a wide range of effects on myocardial electrical activity; at the same time, magnesium can activate myocardial adenosyl cyclase, maintain the integrity of mitochondria and promote its Oxidative phosphorylation process; magnesium can activate Na+-K+-ATPase, prevent the outflow of intracellular potassium; make extracellular potassium enter the cell, reduce the blood K+ concentration, so as to restore the polarization state of ischemia-damaged cardiomyocytes, Inhibit reentry, reduce the occurrence of arrhythmia; and can provide energy, strengthen myocardial contractility. Precautions for the use of polaroidsElderly diabetic patients due to gastric Intestinal dysfunction, low liver and kidney function, etc. are prone to hypoglycemia, and the symptoms are often atypical, which can easily cover up the disease. If not diagnosed and treated in time, it will cause serious adverse consequences. So, what should be paid attention to in elderly diabetic patients using polarized fluid therapy? 1. Strictly grasp the patient’s health and medication statusComprehensive assessment of the patient’s health status before applying magnesium polarizing solution , Routine examination of liver and kidney function, such as liver and kidney dysfunction, the dose should be small, half or 1/3 of the adult dose can be used as the starting dose. Learn more about medication, before infusion of magnesium polarized solution and its processAvoid taking aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, especially multiple drugs at the same time. If these drugs are used at the same time as the application of magnesium polarized liquid, the hypoglycemic effect of these drugs should be considered, and the dosage of insulin should be appropriately reduced. Closely observe the condition, and at the same time slow down the speed of intravenous infusion of magnesium polarized solution. 2. Do a good job in the education of medication knowledgeThe education of medication knowledge is the top priority. Before taking the medicine, explain to the patients and their families why this medicine is used, the effect of this medicine, the clinical manifestations of hypoglycemia and a brief treatment method. And instruct patients or their families to prepare some sugar for consumption. Once the hypoglycemia reaction occurs, it should be reported to the medical staff in time and dealt with in time. 3. Avoid instilling too fastIn the case of intravenous infusion of magnesium polarized solution, it must be The specific situation and the dosage of insulin should be adjusted to the drip rate, and the amount of insulin entering the body should not exceed 2.5-3.0U/h. Strictly control the infusion rate. For elderly patients with coronary heart disease and cardiac insufficiency, the rate of infusion should be limited and the infusion rate should be 20-30 drops/minute. 4. Strive for accurate dosageBe sure to use an insulin syringe when preparing magnesium polarized solution plus insulin to ensure that The dose is accurate. 5. Urge the patient to have meals on timeIntravenous infusion of magnesium polarized solution within 2 hours after meals. Nurses should provide convenience for patients to eat, such as the application of intravenous indwelling needles to facilitate patient movement. 6. Strengthen inspections and closely observe changes in the conditionIn addition to the typical symptoms of hypoglycemia in elderly patients, hypoglycemia It can also be manifested as neuropsychiatric symptoms of reduced cerebral cortex function, such as unresponsiveness, lethargy, and unsteady gait; hallucinations, strange behavior and other mental disorders; even convulsions, limb paralysis, coma, etc., which are easy to cover up the disease. It is easy to be misdiagnosed as cerebrovascular disease, so the awareness of prevention of hypoglycemic encephalopathy should be improved to avoid misdiagnosis. In the event of serious adverse reactions, the magnesium polarized solution should be stopped immediately, blood sugar should be detected in time, and corresponding judgment and treatment should be made. In clinical nursing work, we will face all kinds of patients, they will ask all kinds of questions, we can only improve our professional knowledge and ask a few more questions about why and how to do it. , Why do this, in order to be aware of, correctly answer the questions of patients and their families, and reduce the occurrence of medical disputes. 
    
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