I'm sitting here wondering about this. What is the "final straw"? When is too much enough? How do you know when the moment has arrived that you just can't take it another moment?
I am truly so exhausted, tired, and completely, utterly worn out from being his caregiver. Not just since January of this year when he had the spinal fusion surgeries.....this started in February 2009 when we first thought he might have had a heart attack. I have been his caregiver ever since.
Today, I got a bit of a break. I thought he was upstairs sleeping. I was downstairs watching a movie. He called me on his cell phone and said he was really sick. I quickly ran up the stairs. He had been feeling like he was going to vomit and reached inside the medicine cabinet for what he thought was a bottle of pepto bismol (pink) and instead, mistakenly grabbed the bottle of caladryl lotion (pink) and gulped it down.
I called poison control. It says to do that on the bottle. I keep the lotion as it's the only thing that works on me when I get poison ivy. So poison control says they don't think that he took enough to harm himself. Then she asked me if he was a basically healthy person and when I got done with the list of all his problems and all his meds......she was singing her own tune! She wanted him to eat and then vomit.
Which he has done non stop for the last hour and a half.
So much so that the toilet has plugged up and I've had to get him a bucket to vomit in, then take it down the hall to the other bathroom to dump.
I just want to give up. Really, truly, completely, totally. I want to run away as fast and as far as I can go.
Now, remember, his cardiologist (the new doc who hadn't seen him before) wants him to taper his atenolol. He was supposed to cut it in half for 5 days and then go off. So I asked him about that. He cut it in half Wed, Thurs and Fri nights, then nothing last night. Could he be having atenolol withdrawal symptoms?
His fever is up to 101.3 - not a symptom of atenol withdrawal. His BP is up to 147/83. It's usually 110/70. His heart rate is 115 and it's usually 70. He is vomiting. Rapid breating. Miserable as a dog.
I asked him if he wants to go to the ER. No
I asked if he wants to call his doctor No
He hasn't had a thing to eat since 10 am this morning except for a few crackers this evening. His glucose is 220, but he hasn't taken his evening insulin.
Not a whole lot I can do. Except just keep breathing myself - one minute to the next.
+++++++++
Sandy, in answer to your comment from yesterday. Hubby has never once adjusted his insulin for what he eats. He takes 14 U in the morning (at whatever time he decides to take it) and another 12 U at night (again - whenever). It's the Humulin R-U500 concentrated, and before surgery it was 32 in the am and 20 at night. He has never adjusted for anything. That's why I consider him to be non-compliant. He refuses to learn about adjusting it.
DW - having another rough day on this roller coaster ride we call "life".
Showing posts with label insulin. Show all posts
Showing posts with label insulin. Show all posts
Sunday, April 24, 2011
Wednesday, April 06, 2011
Needles, syringes, humulin R-U 100, U-500, the little differences that impact life!
By the end of this article, I hope you see how the hospital staff could have ended my husband's life because of simple mistakes, and a lack of education. When it comes to diabetes and hospital staff, I don't think there has been near enough education. And with the rapidly increasing number of diabetics out there....it's going to reach a crisis before too long.
Good article:
Click here
Humulin R U-500 concentrated is a form of Human insulin which is 500 units/ml and is 5 times more concentrated than Humulin R U-100 aka Humulin Regular or Regular Humulin. This is my starting base as this is what hubby takes.
BUT.....R U-500 is also called Regular Humulin (see the "R"?)
There is also Humulin R U-100 which is called Regular Humulin. Ahhh....see the confusion starting already???
U-500 (which is what I've decided to call the concentrated type) takes effect w/i 30 minutes (fast acting)
but it is also long-acting as it will last up to up to 24 hours duration
Note: If you take it at 7:00 am (breakfast) and 5 pm (dinner) there is a build-up, a half-life to the amount you take.
It is used in both type 1 and type 2 diabetes
It is useful for the treatment of insulin-resistant patients
It is used in diabetics who need a lot of insulin.
usually given 2 or 3 times daily before meals. Should be followed by a meal within 30 minutes of administration
may be administered in the abdominal wall, thigh, or upper arm. Abdominal wall ensures a faster absorption than other sites. Personal expeience is that it causes bruises in the stomach. Imporatnt to hit a different spot each time.
Use a U-100 insulin syringe = divide the units of U-500 by 5
So 50 units of U-500 is number 10 (units) on a U-100 insulin syringe.
If you use a tuberculin syringe (volume in mL, use a chart provided
Example. 50 units of Humulin R U-500 dose (units) would be 0.1 on a tuberculin syringe
75units would be 0.15
100 units would be 0.2
U-500 Insulin
Most insulin products are supplied from the manufacturer in a 100 unit/mL concentration. The insulin is then administered using an insulin syringe specially designed for use with this concentration of insulin. When a patient needs a dose of 40 units, a caregiver draws the insulin to the designated 40-unit marking on the insulin syringe. However, there is a more concentrated form of insulin that comes as a 500 unit/mL concentration.
The use of U-500 insulin has been increasing due to factors including an escalating obesity epidemic, increasing insulin resistance, growing use of insulin pumps, and rising usage of high doses for tight glucose control. However, there are no insulin syringes designed to measure doses of U-500 insulin (in the US) ; therefore, healthcare practitioners are forced to prescribe, dispense, and administer U-500 insulin using insulin syringes designed for 100 units/mL insulin or other syringes marked in mL. For example, a patient using U-500 insulin with a U-100 syringe might state his dose as “40 units” because he is reading 40 units on the U-100 syringe he used to administer the insulin. However, he is actually administering 200 units of insulin because of the higher concentration. This increases the risk that a fivefold dosing error will occur when the patient communicates his dose to a healthcare practitioner.
The prescribed dose of Humulin R U-500 should always be expressed in actual units of
Humulin R U-500 along with corresponding markings on the syringe the patient is using (i.e., a U-100 insulin syringe or tuberculin syringe
My husband's pre-surgery dose of 32 units of RU 500 would be 160 units of RU 100. (32 x 5 = 160)
Hospital gave hubby 16 units of novulog. They converted 32 straight across and cut it in half because he was NPO. Thus, he received 10% of what he should have received. No wonder his glucose shot to 400 the next morning! This is a common/typical mistake made by hospital staff.
Good information
To switch from regular to concentrated:
The total daily dose of U-100 insulin is added up, and then diided by 5 to indicate the U-500 insulin requirement. Then reduce the U-500 requirement by 10 – 20% and divide the remainder throughout the day. 60% pre breakfast, 40% pre dinner.
So, to switch from concentrated to regular:
Add the total amount of U-500 given per day, then increase by 10 – 20% ,then multiply by 5. This will give you the total amount of U-100 insulin needed.
I can't begin to do the math going backwards!!!
People have asked why hubby is not on metforim. You can't take it if you have renal impairment. My understanding is that if the kidneys are functioning less than 50%, then you are considered to have renal impairment.
The vial of U-500 insulin looks almost identical to a vial of U-100 insulin. The word "concentrated" is in small type and you actually have to hunt to find it.
U-500 is usually not available in hospital pharmacies, so patient must take their own with them to the hospital. Upon admission to a hospital, ask to have their endocrinology staff brought on board immediately. Patient’s chart should clearly indidcate that the patient isusing U-500 insulin.
In hubby's situation, I said he was taking Humulin R-U 500 concentrated. The Pharm D STUDENT who admitted him wrote down Humulin Regular which everyone then interpreted to be Humulin R -U 100.
In some situations, patients need to be fasting and hence intra-venous insulin is required. Insulin resistance is increased in acute ill-nesses and thus insulin requirements can be greater. It is crucial that the ward nursing staff/pharmacist clearly identify, label, store, dispense and inject the U-500 insulin separately from U-100 insulin. These patients may need a steep sliding scale at higher blood glucose levels.
another article
hospital errors
Syringes:
there are 2 kinds of insulin syringes. We have literally been to hospitals that do not stock insulin syringes! ICU at this last hospital did not have insulin syringes available. They did manage to get some from another floor. ICU without insulin syringes?????
1/2ML – u100
1 ML – u100
1 ml of insulin fluid has 100 standard “units” of insulin.
1cc (1ml) syringe holds a maximum of 100 units,numbered in 10 unit increments. The smallest line is 2 units. The smallest measure is 1 unit
1/2cc (0.5 ml) or ½ ml syringe holds a maximum of 50 units, numbered in 10 unit increments, the smallest measureis 1 unit.
U-100 insulin syringes have shorter needles, finer gauge needles for less pain. You want these!!!
Standard hypodermic syrines measure in cc and have larger gauge needles which will cause more pain.
good article on this
14 units on the ½ ML syringe is actually (14x5) 70 units of U-500 because you convert the dose of U-500 to U-100 volume equivalents in order to use the U-100 insulin syringe.
Ah! See where the staff's confusion comes in? They don't want to convert anything!!!
A standard tuberculin syringe measures volume in milliliters. But they do not come in 30 ga needles. Tuberculin gauges are 26 or 27 – bigger than insulin needles. (the larger the number, the smaller the size when it comes to gauges).
The Rx should be written as:
Insulin dose is 70 units, using U-500 insulin. This is equal to 14 units (.14ml) when measured in a U-100 insulin syringe.
Because U-500 is pretty rare, hospital staff is not trained in it's use. Therefore, spouses have to be the ones who are educated in the event that the diaetic can't communicate (how sad is that?) Spouses HAVE to be vigilant and check each does that is administered because each change of staff brings on a "new" nurse that has not bee educated. Doctors and nurses all want to switch from U-500 to U-100, but because the reverse formula is so difficult (adding back in the 10% reduction, giving consideration to changes in weight, etc) and because the patient will now need 5 times the "volume" of insulin (going from 25 units of U-500 to 125 units of U-100), and the timing of injections because U-500 is both fast acting and long acting).....it really does create a nightmare for the patient. Unless hospital staff are willing to test every 2 hours and adjust H and N types of insulin for the patients needs, it's just not going to work. And considering that my husband would go up to 6 hours without anyone checking anything...it would have been disastrous!!!
Needless to say, just the original PharmD student misunderstanding what I clearly said to him was a big enough disaster going into the first operation.
Insulin usage/doseage in hospitals is simply something that spouses are going to have to remain aggressive about. I don't see any medical staff understanding or wanting to understand U-500 and I have a feeling from what I've read online that most don't understand the regular, normal stuff
Here's hoping my research helps someone else. Feel free to print it out and hand it to the surgeon and the hospital pharmacy. They might as well love you as much as they loved me! :o)
DW
Good article:
Click here
Humulin R U-500 concentrated is a form of Human insulin which is 500 units/ml and is 5 times more concentrated than Humulin R U-100 aka Humulin Regular or Regular Humulin. This is my starting base as this is what hubby takes.
BUT.....R U-500 is also called Regular Humulin (see the "R"?)
There is also Humulin R U-100 which is called Regular Humulin. Ahhh....see the confusion starting already???
U-500 (which is what I've decided to call the concentrated type) takes effect w/i 30 minutes (fast acting)
but it is also long-acting as it will last up to up to 24 hours duration
Note: If you take it at 7:00 am (breakfast) and 5 pm (dinner) there is a build-up, a half-life to the amount you take.
It is used in both type 1 and type 2 diabetes
It is useful for the treatment of insulin-resistant patients
It is used in diabetics who need a lot of insulin.
usually given 2 or 3 times daily before meals. Should be followed by a meal within 30 minutes of administration
may be administered in the abdominal wall, thigh, or upper arm. Abdominal wall ensures a faster absorption than other sites. Personal expeience is that it causes bruises in the stomach. Imporatnt to hit a different spot each time.
Use a U-100 insulin syringe = divide the units of U-500 by 5
So 50 units of U-500 is number 10 (units) on a U-100 insulin syringe.
If you use a tuberculin syringe (volume in mL, use a chart provided
Example. 50 units of Humulin R U-500 dose (units) would be 0.1 on a tuberculin syringe
75units would be 0.15
100 units would be 0.2
U-500 Insulin
Most insulin products are supplied from the manufacturer in a 100 unit/mL concentration. The insulin is then administered using an insulin syringe specially designed for use with this concentration of insulin. When a patient needs a dose of 40 units, a caregiver draws the insulin to the designated 40-unit marking on the insulin syringe. However, there is a more concentrated form of insulin that comes as a 500 unit/mL concentration.
The use of U-500 insulin has been increasing due to factors including an escalating obesity epidemic, increasing insulin resistance, growing use of insulin pumps, and rising usage of high doses for tight glucose control. However, there are no insulin syringes designed to measure doses of U-500 insulin (in the US) ; therefore, healthcare practitioners are forced to prescribe, dispense, and administer U-500 insulin using insulin syringes designed for 100 units/mL insulin or other syringes marked in mL. For example, a patient using U-500 insulin with a U-100 syringe might state his dose as “40 units” because he is reading 40 units on the U-100 syringe he used to administer the insulin. However, he is actually administering 200 units of insulin because of the higher concentration. This increases the risk that a fivefold dosing error will occur when the patient communicates his dose to a healthcare practitioner.
The prescribed dose of Humulin R U-500 should always be expressed in actual units of
Humulin R U-500 along with corresponding markings on the syringe the patient is using (i.e., a U-100 insulin syringe or tuberculin syringe
My husband's pre-surgery dose of 32 units of RU 500 would be 160 units of RU 100. (32 x 5 = 160)
Hospital gave hubby 16 units of novulog. They converted 32 straight across and cut it in half because he was NPO. Thus, he received 10% of what he should have received. No wonder his glucose shot to 400 the next morning! This is a common/typical mistake made by hospital staff.
Good information
To switch from regular to concentrated:
The total daily dose of U-100 insulin is added up, and then diided by 5 to indicate the U-500 insulin requirement. Then reduce the U-500 requirement by 10 – 20% and divide the remainder throughout the day. 60% pre breakfast, 40% pre dinner.
So, to switch from concentrated to regular:
Add the total amount of U-500 given per day, then increase by 10 – 20% ,then multiply by 5. This will give you the total amount of U-100 insulin needed.
I can't begin to do the math going backwards!!!
People have asked why hubby is not on metforim. You can't take it if you have renal impairment. My understanding is that if the kidneys are functioning less than 50%, then you are considered to have renal impairment.
The vial of U-500 insulin looks almost identical to a vial of U-100 insulin. The word "concentrated" is in small type and you actually have to hunt to find it.
U-500 is usually not available in hospital pharmacies, so patient must take their own with them to the hospital. Upon admission to a hospital, ask to have their endocrinology staff brought on board immediately. Patient’s chart should clearly indidcate that the patient isusing U-500 insulin.
In hubby's situation, I said he was taking Humulin R-U 500 concentrated. The Pharm D STUDENT who admitted him wrote down Humulin Regular which everyone then interpreted to be Humulin R -U 100.
In some situations, patients need to be fasting and hence intra-venous insulin is required. Insulin resistance is increased in acute ill-nesses and thus insulin requirements can be greater. It is crucial that the ward nursing staff/pharmacist clearly identify, label, store, dispense and inject the U-500 insulin separately from U-100 insulin. These patients may need a steep sliding scale at higher blood glucose levels.
another article
hospital errors
Syringes:
there are 2 kinds of insulin syringes. We have literally been to hospitals that do not stock insulin syringes! ICU at this last hospital did not have insulin syringes available. They did manage to get some from another floor. ICU without insulin syringes?????
1/2ML – u100
1 ML – u100
1 ml of insulin fluid has 100 standard “units” of insulin.
1cc (1ml) syringe holds a maximum of 100 units,numbered in 10 unit increments. The smallest line is 2 units. The smallest measure is 1 unit
1/2cc (0.5 ml) or ½ ml syringe holds a maximum of 50 units, numbered in 10 unit increments, the smallest measureis 1 unit.
U-100 insulin syringes have shorter needles, finer gauge needles for less pain. You want these!!!
Standard hypodermic syrines measure in cc and have larger gauge needles which will cause more pain.
good article on this
14 units on the ½ ML syringe is actually (14x5) 70 units of U-500 because you convert the dose of U-500 to U-100 volume equivalents in order to use the U-100 insulin syringe.
Ah! See where the staff's confusion comes in? They don't want to convert anything!!!
A standard tuberculin syringe measures volume in milliliters. But they do not come in 30 ga needles. Tuberculin gauges are 26 or 27 – bigger than insulin needles. (the larger the number, the smaller the size when it comes to gauges).
The Rx should be written as:
Insulin dose is 70 units, using U-500 insulin. This is equal to 14 units (.14ml) when measured in a U-100 insulin syringe.
Because U-500 is pretty rare, hospital staff is not trained in it's use. Therefore, spouses have to be the ones who are educated in the event that the diaetic can't communicate (how sad is that?) Spouses HAVE to be vigilant and check each does that is administered because each change of staff brings on a "new" nurse that has not bee educated. Doctors and nurses all want to switch from U-500 to U-100, but because the reverse formula is so difficult (adding back in the 10% reduction, giving consideration to changes in weight, etc) and because the patient will now need 5 times the "volume" of insulin (going from 25 units of U-500 to 125 units of U-100), and the timing of injections because U-500 is both fast acting and long acting).....it really does create a nightmare for the patient. Unless hospital staff are willing to test every 2 hours and adjust H and N types of insulin for the patients needs, it's just not going to work. And considering that my husband would go up to 6 hours without anyone checking anything...it would have been disastrous!!!
Needless to say, just the original PharmD student misunderstanding what I clearly said to him was a big enough disaster going into the first operation.
Insulin usage/doseage in hospitals is simply something that spouses are going to have to remain aggressive about. I don't see any medical staff understanding or wanting to understand U-500 and I have a feeling from what I've read online that most don't understand the regular, normal stuff
Here's hoping my research helps someone else. Feel free to print it out and hand it to the surgeon and the hospital pharmacy. They might as well love you as much as they loved me! :o)
DW
Friday, December 14, 2007
Today's nephrology visit
I think I'm exhausted and it was his appointment. His HMO does not have a nephrologist, so this was a referral outside the system. Of course, there is not a whole lot that she can do other than make observations. Sigh.
His A1c is normal. You wouldn't believe the look I got from her when I said that he is having a lot of lows and must be having highs to balance out the A1c. I immediately knew she did not like me, did not want me there, did not want to hear any of this.
And it's such a game with him. She asked if his doctor had talked to him about diet and limiting salt. He said yes and that we use "no salt" or salt substitutes. She said, "good, good". And then I said that yes, they had talked to him about that, but he loves to eat out and that he doesn't really follow any of the recommended diet plans. Again, I got "that look".
They had taken him off allopurinol and colchicine because his creatine levels had gone up. She put him back on 100mg /day of allopurinol and is giving him a 9 day burst of prednisone. I was a bit surprised with this as it works to raise blood sugars. And not once did she mention to him or ask him about daily glucose monitoring. Sigh.
Further, she told him to go back on the colchicine as needed for pain, up to 1 every other day. So, does this mean that his creatine levels will go back up?
He is on Novulin N 66 twice a day and R 30 twice a day. She asked him to cut back his salt and cut back his lasix. His weight is up to 246 pounds. A gain of 25 pounds this year. She did tell him that he is stage 3 CKD, his function is now at 32% and that yes, it can go up after being down....that the creatine levels were probably up due to too many drugs (which she is putting him back on).
She wants to see him every 6 months.
I asked her about a non-invasive glucose monitor/pump like MiniMed Paradigm Real-Time of CGMS system Gold. She said we need to see his endocrinologist for that. He does not have one. He only has a rheumatologist and a primary care physician.
I explained the peeks/valleys that I see with Novolin R& N and asked about Lantus/Novolog or novorapid and again, she said see the primary care or endocrinologist.
I inquired about remedies for depression, foot pain, headaches (suggested a pain management clinic).....and with each one...she said we needed to see the primary care.
So on the way home, I suggest that he make an appointment to see his primary care as soon as he could and to have his labs redone in 2 weeks to see the impact of prednisone and the other drugs on all his levels.
He's gone back to his HMO now to get his RX filled, but I could tell he was a bit depressed. I think it's more because I was there asking questions rather than any answer she was giving us. But I can also see that he is obviously not giving these doctors the full, complete picture.
I did also mention that he cannot exercise due to the pain in his feet, knees, hips and back. Again, she said there wasn't much she could do about it.
I'm wonder if a nephrologist really only comes into play when a patient gets to stage 4? Or perhaps look at the combination of drugs they are currently on? But she really couldn't make a change in the type of insulin he is getting which I found interesting, but probably has more to do with the fact that this was a referral outside his HMO.
I will just continue to make my observations here, keep this as my notes to refer back to, and wait for the next doctor's visit. In the meantime, until he wants to make changes in his diet, I don't see much else that can be done.
His A1c is normal. You wouldn't believe the look I got from her when I said that he is having a lot of lows and must be having highs to balance out the A1c. I immediately knew she did not like me, did not want me there, did not want to hear any of this.
And it's such a game with him. She asked if his doctor had talked to him about diet and limiting salt. He said yes and that we use "no salt" or salt substitutes. She said, "good, good". And then I said that yes, they had talked to him about that, but he loves to eat out and that he doesn't really follow any of the recommended diet plans. Again, I got "that look".
They had taken him off allopurinol and colchicine because his creatine levels had gone up. She put him back on 100mg /day of allopurinol and is giving him a 9 day burst of prednisone. I was a bit surprised with this as it works to raise blood sugars. And not once did she mention to him or ask him about daily glucose monitoring. Sigh.
Further, she told him to go back on the colchicine as needed for pain, up to 1 every other day. So, does this mean that his creatine levels will go back up?
He is on Novulin N 66 twice a day and R 30 twice a day. She asked him to cut back his salt and cut back his lasix. His weight is up to 246 pounds. A gain of 25 pounds this year. She did tell him that he is stage 3 CKD, his function is now at 32% and that yes, it can go up after being down....that the creatine levels were probably up due to too many drugs (which she is putting him back on).
She wants to see him every 6 months.
I asked her about a non-invasive glucose monitor/pump like MiniMed Paradigm Real-Time of CGMS system Gold. She said we need to see his endocrinologist for that. He does not have one. He only has a rheumatologist and a primary care physician.
I explained the peeks/valleys that I see with Novolin R& N and asked about Lantus/Novolog or novorapid and again, she said see the primary care or endocrinologist.
I inquired about remedies for depression, foot pain, headaches (suggested a pain management clinic).....and with each one...she said we needed to see the primary care.
So on the way home, I suggest that he make an appointment to see his primary care as soon as he could and to have his labs redone in 2 weeks to see the impact of prednisone and the other drugs on all his levels.
He's gone back to his HMO now to get his RX filled, but I could tell he was a bit depressed. I think it's more because I was there asking questions rather than any answer she was giving us. But I can also see that he is obviously not giving these doctors the full, complete picture.
I did also mention that he cannot exercise due to the pain in his feet, knees, hips and back. Again, she said there wasn't much she could do about it.
I'm wonder if a nephrologist really only comes into play when a patient gets to stage 4? Or perhaps look at the combination of drugs they are currently on? But she really couldn't make a change in the type of insulin he is getting which I found interesting, but probably has more to do with the fact that this was a referral outside his HMO.
I will just continue to make my observations here, keep this as my notes to refer back to, and wait for the next doctor's visit. In the meantime, until he wants to make changes in his diet, I don't see much else that can be done.
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