Acute Care - Diabetes Treatment

By editor | August 15, 2007

The initial management of Type 1 diabetes is about the same for adults and children. Most physicians will give small amounts of insulin continuously or hourly in relation to the person’s size and in relation to the state of ketoacidosis and dehydration. In fact, some intravenous fluids are usually given before insulin. Just think about this: If you have a glass half filled with water and you put 10 tea-spoons of sugar in it, would you have a faster response in lowering the amount of sugar in each teaspoon of liquid if you put in some thing to use up the sugar or if you filled the glass to the top with water? It’s the same with the human body. Fluid is added, then insulin is started. When the laboratory work comes back, other chemicals such as potassium are added if necessary. Also, in most cases the doctor will not add the potassium until the person passes urine (otherwise, the potassium would become too concentrated in the body and cause problems).

The rate of fall of the blood-glucose levels is usually controlled so that it does not exceed much more than 100 mg/dl (5-6 mmol) per hour. This helps the body in its re-balancing process. It also helps prevent headaches, since the brain would otherwise get too much of a jolt in having the sudden greater amount of fluid and lesser amount of sugar. Saline, or salt water, may be used first, as it aids the tissues in accepting the fluid that is needed. Later on, glucose is added to the saline, or the total intravenous fluid is changed to a glucose solution. This may seem strange when the problem was initially caused by too much glucose in the system. However, the glucose in the water does a number of things. For one, it prevents the person from becoming hypoglycemic. For another, it prevents the person from making ketones from free fatty acids when the body recognizes that it needs something for energy.

To monitor the other chemicals in the body to be sure they are not out of balance, it is necessary to do blood tests every few hours. Usually, the blood is drawn through a plastic needle placed in a vein; to prevent clotting, very small amounts of heparin are put into the needle once the blood has been removed (this is called a “heparin lock”). Each time a specimen is needed, the heparin fluid is with drawn, and the amount of blood needed is removed. Heparin is then replaced in to the needle space until the next specimen is needed. This step prevents the need to stick a person many times to obtain these blood specimens. This plastic needle may be kept in place until the intravenous infusion (IV) is discontinued or after the first day or two (ie., 6 to 48 hours).

Another way of testing how well a person is doing is by looking at the cardiac monitor. Not only can the nurses and doctors tell whether chemicals such as potassium are at low or high levels, they can also tell whether calcium, magnesium, or other chemicals called electrolytes are out of balance. Actually, when there is adequate fluid replacement in the face of the appropriate amount of insulin, the other chemicals seem to balance out.


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