You are caring for a patient who has been hospitalized for 3…

You are caring for a patient who has been hospitalized for 3 days secondary to new onset congestive heart failure with exacerbation. The patient is also a type II diabetic. On admission the patient’s home insulin regimen was continued: Lantus 20 units subcutaneous HS, lispro (Humalog) 6 units subcutaneous before meals.  You are reviewing the patient’s glucose trend shown below:   Tuesday Wednesday Thursday Before Breakfast 62 58 65 Before Lunch 158 128 165 Before Dinner 201 199 205 Bedtime 198 212 188 What insulin adjustment is most appropriate for this patient? 

A 19 year old female presents to the emergency department wi…

A 19 year old female presents to the emergency department with complaints from her best friend of “she isn’t acting her normal self”. The patient is lethargic though awakens to voice, tachypneic, diaphoretic, with poor skin turgor. Her best friend reports she hasn’t felt good for two days, but has progressively worsened. The patient denies any medical problems, smoking, or drug use. She reports she is not currently sexually active.  She complains of extreme thirst and fatigue.  Labs: WBC 20K, H&H 17.5 & 45, Plt 450K. Na+ 129, K+ 5.6, anion gap 25, Cr 1.8, BUN 40, Ca+ 8.5, glucose 448.  Vitals: Temp 97.8F, Pulse 122, BP 104/54, RR 34, O2 96% on room air.  Which diagnostic test is the most appropriate to order next? 

A 19 year old type I diabetic female has been in the intensi…

A 19 year old type I diabetic female has been in the intensive care unit for 2 days secondary to diabetic ketoacidosis (DKA). The insulin drip is infusing at 2units/hr. Suddenly the nurse notifies the AGACNP intensivist that the patient appears to be having a seizure. The seizure resolves after IV administration of a benzodiazepine. The nurse obtains a point of care glucose which results as 32.  What is the most appropriate treatment?