Identifying Which Patients Are In Need Of Insulin

Patients in need of treatment with insulin must be identified
early. This is done by judging the patient’s clinical features;
blood glucose concentrations alone offer a relatively poor
guide, although most patients with a blood glucose
concentration greater than 25 mmol/l are likely to need
insulin.

Features suggesting need for insulin are:
• a rapid development of symptoms
• substantial weight loss—patients are usually thin and
demonstrate a dry tongue or more severe dehydration
• weakness
• the presence of ketonuria.
If their condition worsens, vomiting can occur and they rapidly
become ketoacidotic; these patients are drowsy, dehydrated,
overbreathing, and their breath smells of acetone (although many people are unable to detect this smell).

 patients are likely to need insulin:
1• almost all children and most of those under 30-40 years
of age
2• women who present during pregnancy
3• diabetic patients whose tablet treatment has failed
4• all patients who have undergone pancreatectomy.

If there is any doubt give insulin. It can never be wrong to do
so, and if the decision was mistaken it can easily be reversed.


Summary about patient types in need of Insulin
Age: Any, more likely under 30 years

Symptoms: 
•Rapid onset  Substantial weight loss
• Weakness
• Vomiting

Signs:

• Usually thin
• Dry tongue
• Weak

Ketoacidosis:

• Drowsiness
• Dehydration
• Overbreathing
• Breath smelling of aceton

Blood glucose concentration
• Any
 

Other indications

1• When tablets have failed during pregnancy
2• When diet has failed during  current illness
3• In patients who have undergone pancreatomy
4• Ill patients need admission
5• Others may start insulin at home
6• If there is any doubt use insulin