Identifying patients 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

• 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).

The following groups of patients are likely to need insulin:

• almost all children and most of those under 30-40 years of age

• women who present during pregnancy

diabetic patients whose tablet treatment has failed

• 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.

Identifying patients in

Symptoms

• Substantial weight loss

• Vomiting Signs

• Weak Ketoacidosis

• Drowsiness

• Dehydration

• Overbreathing

• Breath smelling of need of insulin

• Any, more likely under 30 years

Blood glucose concentration

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