Insulin/insulin glargine
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Hypoglycaemia: case report A 66-year-old woman developed hypoglycaemia during treatment with insulin and insulin glargine for hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS) [not all dosages stated]. The woman was hospitalised with HHNS secondary to septic shock. Her an initial blood glucose (BG) was 538 mg/dL. On the day of the admission, she was intubated, and the HbA1C was 16%. She started receiving therapy with IV insulin drip to decrease BG level and hydrocortisone for septic shock. At 03:00 of hospitalisation day 2, the point of care testing (POCT) BG dropped to 54 mg/dL. The insulin drip was stopped, and the woman was treated with IV 50% dextrose. Eventually, the BG level normalised to 108–209 mg/dL. After 18 hours, enteral tube feed was initiated, and her BG elevated to 174–315 mg/dL. She received SC insulin glargine 15 units twice daily along with correctional insulin. Her hydrocortisone therapy and tube feed were continued. At midnight of hospitalisation day 4, she again exhibited hypoglycaemia with a POCT BG 37 mg/dL. Ten doses of dextrose 12.5g and one dose of glucagon 1mg were administered as IV push from 04:00 to 18:00 due to persistent hypoglycaemia. Additionally, IV infusion of 10% dextrose was started at 50 mL/h at 15:00. Despite these therapies, her hypoglycaemic (BG: ranging from 37–83 mg/dL) persisted. Thereafter, octreotide was started for the refractory hypoglycaemia, and her BG increased. Her BG remained normal, and octreotide was stopped after two doses. Author comment: "Subcutaneous insulin glargine 15 units twice daily and correctional insulin were started while IV hydrocortisone and tube feed were continued. At midnight of day 4 admission, she again became hypoglycemic". Fong I, et al. Octreotide for the treatment of persistent hypoglycemia in a critically ill patient. Critical Care Medicine 47 (Suppl. 1): abstr. 303, No. 1, Jan 2019. Available from: URL: https://journals.lww.com/ccmjournal/ Citation/2019/01001/303__OCTREOTIDE_FOR_THE_TREATMENT_OF_PERSISTENT.268.aspx 803432204 [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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