Home after a crazy day

I checked in with K's nurse at 7:30am this morning, and discovered that a blood glucose (BG) hypoglycemia emergency was brewing, and they didn't even know it yet. They had given her a total of 32 units of Humalog (a fast-acting insulin) during the night, while chasing a high BG that only required 4 units. By my calculation, that would have driven her blood sugar down to negative 4,200 over the next few hours! An impossibility, for sure, but also surely enough to kill her, if left unchecked, by taking BG down to zero, and holding it there.

They didn't allow for (and didn't even want to consider) the time it takes even fast-acting Humalog to be metabolized. Someone must have fooled these people into thinking that insulin takes effect immediately. I had told them that each unit of Humalog will drive her BG down by 150, at a rate of about 60 per hour. In this case, they started at 719 BG at 1145pm, so after giving her the correct 4 units of Humalog to bring it down by 600, it would have taken about 10 hours, to get to a normal number in the 100 range, sometime around 10am. Instead, they measured periodically, and treated the number they saw each time. So they gave her 10, 10, 8, and 4 units throughout the early morning.

They had measured a BG of 419 at 4am, and I guess they felt confident that they would need even more insulin soon, and weren't even a little worried that her BG would be going too low. I warned her Nurse and the Charge Nurse that she'd be crashing soon, and that they would probably need IV dextrose to stop it. I recommended that they measure her immediately, even though they were in the middle of the RN shift change. Sure enough, they measured a BG of 58, way too low. They measured again, to be sure, and got a BG of 34, critically low.

Luckily they were in a hospital, and had easy access to intravenous dextrose. They gave her a shot of 50 mL of D50 push, which raised her BG to around 240 over the next hour or so. Amazingly, her BG didn't drop below that later, as I feared it would, but instead hovered at 240 for several hours, then started trending up, after she ate lunch. The D50 had completely offset the excess Humalog. We've gotta get ourselves some of that stuff! If only we could.

They tried very hard to get her discharged during the day, but she wanted to wash up, and have dinner before she left. Then she wanted to peruse the hospital gift shop windows, even though the shop was closed, and I had locked myself out, by going out the automatic doors after 8pm when they stop letting people in that way. I didn't finally get her out the door and into the car, until after 9pm.