# Insulin



## WuLabsWuTecH (Jul 19, 2009)

I was just curious.  r/r on another thread mentioned something about never giving insulin.  I thought paramedics had it in their protocol to give insulin on some services/in some states.

Do any of you paramedics give insulin?

I would assume you wouldn't give it b.c its so hard to stock, but am i missing something else here?


----------



## medic417 (Jul 19, 2009)

Yes I do in my rural service but most city Paramedics do not. 


Not hard to stock.


----------



## wyoskibum (Jul 19, 2009)

WuLabsWuTecH said:


> Do any of you paramedics give insulin?



AFAIK, administration of insulin is not part of the Paramedic Curriculum.  

A lot of the issues we see are the insulin dependent diabetics who either take too much insulin or forget to eat after taking their insulin and they become hypoglycemic.  This is an acute event and needs to be corrected immediately.

Hyperglycemic events tend to be chronic problems and is usually spotted before it becomes critical.  The occasion is rare and unless your in a wilderness setting or extended transport, most patients can wait until the hospital for insulin.


----------



## ResTech (Jul 19, 2009)

> most patients can wait until the hospital for insulin.



... and all awhile, administer the fluid bolus enroute to start to decrease the BG level.


----------



## mycrofft (Jul 19, 2009)

*Yeah, you start juggling insulin and blood sugars and get trouble.*

If you pick up a comatose diabetic, though, you might grab their insulin and bring it. They might find that regular and long-acting have become intermixed, or the insulin is no longer potent due to outdate or etc.


----------



## ResTech (Jul 19, 2009)

I wouldnt think insulin would be out-of-date since it is administered everyday to sustain life. Unlike nitro, were it may never get used.


----------



## Shishkabob (Jul 19, 2009)

They could have stocked up at Costco.


----------



## marineman (Jul 19, 2009)

by protocol we are allowed to administer it during an IFT but we don't carry it and we don't give it on a 911 call. 

Insulin isn't a drug covered in the paramedic curriculum and I haven't taken the course yet but I think it is covered in the CCEMTP course.


----------



## Ridryder911 (Jul 20, 2009)

marineman said:


> by protocol we are allowed to administer it during an IFT but we don't carry it and we don't give it on a 911 call.
> 
> Insulin isn't a drug covered in the paramedic curriculum and I haven't taken the course yet but I think it is covered in the CCEMTP course.



It's covered as to maintain an Insulin drip. I know of NO EMS that has such protocols other than to do such. Do you have a refigerator in the back of your units to store it? Regular Insulin is the only IV Insulin and it is fast acting, usually requires refrigeration. I would NEVER administer without a lab base line value. 

R/r 911


----------



## WuLabsWuTecH (Jul 20, 2009)

Rid-that's what I meant by hard to store, but a few rigs in my city now have freezers on board to carry ice for cardiac arrests...


----------



## akflightmedic (Jul 20, 2009)

Ridryder911 said:


> It's covered as to maintain an Insulin drip. I know of NO EMS that has such protocols other than to do such. Do you have a refigerator in the back of your units to store it? Regular Insulin is the only IV Insulin and it is fast acting, usually requires refrigeration. I would NEVER administer without a lab base line value.
> 
> R/r 911



We have had this discussion before...we carried it in Alaska but we also had an i-STAT machine.


----------



## medicdan (Jul 20, 2009)

Ridryder911 said:


> It's covered as to maintain an Insulin drip. I know of NO EMS that has such protocols other than to do such. Do you have a refigerator in the back of your units to store it? Regular Insulin is the only IV Insulin and it is fast acting, usually requires refrigeration. I would NEVER administer without a lab base line value.
> 
> R/r 911


You wouldnt administer based on FSBS? Not even under direct order from an MD (if BS is X, give X units Insulin)?


----------



## medic417 (Jul 20, 2009)

Ridryder911 said:


> It's covered as to maintain an Insulin drip. I know of NO EMS that has such protocols other than to do such. Do you have a refrigerator in the back of your units to store it? Regular Insulin is the only IV Insulin and it is fast acting, usually requires refrigeration. I would NEVER administer without a lab base line value.
> 
> R/r 911



We carry insulin.  We have refrigerator in the ambulance.  We have other meds that require refrigeration as well.   Again I am a long way from even a level 4 hospital.

At my service that has a hospital nearby we do not carry insulin.


----------



## Melclin (Jul 20, 2009)

WuLabsWuTecH said:


> Rid-that's what I meant by hard to store, but a few rigs in my city now have freezers on board to carry ice for cardiac arrests...



Ice for cardiac arrests? Do you mean for post-ROSC hypothermia? You use ice for that?


----------



## VentMedic (Jul 20, 2009)

Melclin said:


> Ice for cardiac arrests? Do you mean for post-ROSC hypothermia? You use ice for that?


 
Hopefully he means for the saline.

Although, when ROSC hypothermia was first attempted prehospital during the 1980s, we did use ice which was a real PIA in Florida. I believe one crew had to raid a slushy stand during a code situation at the beach.


----------



## Melclin (Jul 20, 2009)

VentMedic said:


> Hopefully he means for the saline.
> 
> Although, when ROSC hypothermia was first attempted prehospital during the 1980s, we did use ice which was a real PIA in Florida. I believe one crew had to raid a slushy stand during a code situation at the beach.



I should hope so. 

While they're at it, they can start a strawberry blitz infusion at 12 units of delicious per brain freeze.


----------



## Ridryder911 (Jul 20, 2009)

akflightmedic said:


> We have had this discussion before...we carried it in Alaska but we also had an i-STAT machine.



Yeah, your situation was different though. 




emt.dan said:


> You wouldnt administer based on FSBS? Not even under direct order from an MD (if BS is X, give X units Insulin)?



What you are refering to is a sliding scale and that is not for extremely high levels. Any decent physician probably would not trust a FSBS check for administration of Regular Insulin as for treating emergency hyperglycemia as most glucometers will only read "High" >500mg/dl. Majority will await to get a baseline labs other than just glucose (if they are smart). As well, I have seen varied levels even on hospitals and await a diluted or second sample to be ran before administering Insulin and Insulin drips. ABG's and other panels need to be evaluated as well. 

One should not be treating as per EMS unit the non-critical hyperglycemia. Doubtful, that you are carrying their specific Insulin and no one should not immediately lower just a high blood sugar. Remember there are specific types (long acting, etc) that the patient's body is used to. Sorry folks, give them some fluids and allow the hospital to care of this.

R/r 911


----------



## Sasha (Jul 20, 2009)

> we carried it in Alaska



Taped to your lightbars to keep it cold!


----------



## MrBrown (Jul 20, 2009)

Melclin said:


> .... they can start a strawberry blitz infusion at 12 units of delicious per brain freeze.



LMAO ... I want 100ml of all syrup squishy from the kwik-e-mart IV!

@ OP - yes our Advanced Paramedics can administer insulin (it's not part of thier scope) if asked to do so by a medical control physician only.


----------



## WuLabsWuTecH (Jul 20, 2009)

I don't really understand what they do with the ice, but something about cooling the patient during a cardiac arrest run?


----------



## marineman (Jul 20, 2009)

Ridryder911 said:


> It's covered as to maintain an Insulin drip. I know of NO EMS that has such protocols other than to do such. Do you have a refigerator in the back of your units to store it? Regular Insulin is the only IV Insulin and it is fast acting, usually requires refrigeration. I would NEVER administer without a lab base line value.
> 
> R/r 911



Correct, poor wording on my part. We are allowed to maintain Insulin drips on IFT's. It's actually a fairly new protocol to us, up until 3 months ago we had to take a nurse with us that could adjust the drip.


----------

