QuestionSBA
QuestionChoice
The patient is able to eat and drink and there is no reason to delay returning to normal oral intake and the patient’s regular subcutaneous insulin
33973
d
Continue VRII for another 12 hours and discontinue if BMs are stable
QuestionChoice
When transitioning from a VRII to normal subcutaneous insulin, the infusion should be left running for 30-60 minutes afterwards to ensure stable BMs
33972
c
Administer insulin lispro with next meal and discontinue VRII
QuestionChoice
As the patient is able to eat and drink, she should restart her usual subcutaneous fast-acting insulin with her next meal with the VRII running for 30-60 minutes afterwards to ensure stable BMs
33970
a
Administer insulin lispro with next meal and continue VRII for 1 hour afterwards
QuestionChoice
The patient’s long-acting insulin should only be returned to normal levels at the time of discharge and not whilst still on a VRII
33974
e
Increase insulin glargine to 22 units SC ON and administer insulin lispro with next meal
QuestionChoice
The patient is able to eat and drink and there is no reason to delay returning to normal oral intake and the patient’s regular subcutaneous insulin
33971
b
Administer insulin lispro with tomorrow's evening meal and continue VRII for 1 hour afterwards
QuestionComment
should say how long ago her surgery was/ how long she should be NBM - extensive bowel resection may need to be NBM for up to 48 hrs 
8353
User
subscriber
Dominant Botox
QuestionComment
where is the guidance on this in the BNF?

40235
QuestionComment
nvm found it under "Diabetes, surgery and medical illness"

40236
User
subscriber
Neoplasia Nightshift
User
subscriber
Neoplasia Nightshift
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2738
Restarting normal SC insulin following a VRII
Topic
13
Neurosurgery
6805
Case Presentation: A 50 year old woman is a surgical inpatient recovering from an elective anterior resection of sigmoid adenocarcinoma. **PH** type 1 diabetes. **DH** insulin lispro (Humalog) 10 units SC TDS with meals, insulin glargine (Lantus) 22 units SC ON.


**O/E**

Alert and oriented. Vital observations stable, surgical site dressing clean with limited strikethrough. Loop ileostomy in RIF, stoma bag collecting yellow liquid stool.

She is currently on insulin glargine (Lantus) 17 units SC ON and has been receiving a variable rate insulin infusion (VRII) for 12 hours since 7pm yesterday. Her pain and nausea are well controlled, and she recently started eating and drinking. She is now due dinner.

Question: Select the most appropriate management with regard to her insulin at this stage.
a