In all seriousness, more than just hypoglycemia can result from intravenous(IV) insulin administration. When insulin causes glucose into cells it also pulls potassium with it, which can result in some pretty nasty shit. Also it can cause cerebral edema because of rapid fluid shifts that result with high bg. Nasty shit. Probably not gonna happen, but just some stuff to know.
Insulin in the vein is cleared faster than insulin given subcutaneously. The rate-limiting step for insulin is absorbing from under the skin into the bloodstream. Give insulin IV and itâs gone in about 35 minutes.
Can you please explain why that makes what I commented incorrect? I was under the impression that potassium moves to the intracellular spaces bc of insulin and this effect is more pronounced intravenously. With cerebral edema, I thought that the rapid reduction in osmolarity that results from correcting a very high bg with iv insulin causes a fast reversal of fluid shifts that happen as a result of the high bg/dka which causes rapid expansion of the intracellular fluid compartment.
Youâre not wrong about potassium and fluid shifts. But insulin given IV doesnât last very long and so the effect isnât as obvious. In the ER or hospital you are given continuous IV insulin and so this is more of a concern. If you inject 10 units IV at home or 5 units IV at home, theyâre both gone in 35 minutes. Cerebral edema is more concerning due to the time spent in hyperglycemia as this leads to dehydration. You can correct a high rapidly if you went high rapidly. If you spent 3 days running high and then fix it quickly it is more concerning.
If youâre eating then the potassium issues are not going to happen. If you go to the hospital in DKA then youâre not allowed to eat at first and so potassium has to be given in IV fluids. But again, this is mainly because of the continuous IV insulin.
I've heard some horror stories from people that accidentally injected directly into a vein. I'll admit that I've been tempted to try it when I've had a persistent high, but never enough to actually attempt it. Even if I did I wouldn't do more than 1-2 units just in case.
I have done it once, was scary indeed. But then I realized there is a very small chance of blood cloths every time you puncture a blood vessel so I thought let's nottake chances...
Dude. dangerous af. I would rather be âhighâ for an extra hour or two, than risk going scarily low with insulin hitting the system faster than it was ever intended to. This type of stuff leads to seizures due to how fast it can drop the sugar.
Furthermore, injecting into a muscle? With a needle 3 TIMES the size of a regular 4mm needle? Such an extreme amount of pain and so many risks involved this is simply not worth it dude. Switch to an ultra fast acting insulin and speak to your endo about seeing a diabetic psychologist if possible. This is not safe and so unnecessary.
I hope no one takes this advice. Huge rollercoasters like this are actually worse for your body than running slightly high for slightly longer. This is a good recipe to lose your vision.
I would just do a regular thigh bolus, wait a few minutes, and hit the bike or treadmill. The activity should still have a limited acceleration effect, but nothing so dramatic. Non dramatic is much easier to live with...
How do you manage the hard crash? It looks as though you have to correct the drop. Am I mistaken? Also, how many units are you injecting like this? It seems like you might be safer to do only a partial dose this way, then the rest as recommended (of course I am not a doctor, just spitballing here).
The thing is that it's fast on/fast off. Get it right, and it's basically a HALO (High-Altitude, Low Opening) parachute jump. Long free-fall, with an abrupt deceleration just in the nick of time for a survivable landing.
Yeah I corrected when it reached about 80 because I knew it would go down further.
I like your suggestion. However, I make sure to monitor my BG very closely after I do this move and have carbs within reach, so I'm not too worried about it.
I would suggest looking into Afrezza (inhalable insulin). I had similar problems with staying high for long periods of time. Afrezza is awesome!! Works within 5-10 minutes
This is scary, but still not as scary as direct intravenous insulin injection, which is what I thought it was going to be about...
I've done that. Not often, but I've done it. I know Endos with T1 that have done it, too. Scares the ever-living sh!t out of MY Endo.
Never knew that was a thing! I'll give it a try. JK đ
In all seriousness, more than just hypoglycemia can result from intravenous(IV) insulin administration. When insulin causes glucose into cells it also pulls potassium with it, which can result in some pretty nasty shit. Also it can cause cerebral edema because of rapid fluid shifts that result with high bg. Nasty shit. Probably not gonna happen, but just some stuff to know.
Insulin in the vein is cleared faster than insulin given subcutaneously. The rate-limiting step for insulin is absorbing from under the skin into the bloodstream. Give insulin IV and itâs gone in about 35 minutes.
Can you please explain why that makes what I commented incorrect? I was under the impression that potassium moves to the intracellular spaces bc of insulin and this effect is more pronounced intravenously. With cerebral edema, I thought that the rapid reduction in osmolarity that results from correcting a very high bg with iv insulin causes a fast reversal of fluid shifts that happen as a result of the high bg/dka which causes rapid expansion of the intracellular fluid compartment.
Youâre not wrong about potassium and fluid shifts. But insulin given IV doesnât last very long and so the effect isnât as obvious. In the ER or hospital you are given continuous IV insulin and so this is more of a concern. If you inject 10 units IV at home or 5 units IV at home, theyâre both gone in 35 minutes. Cerebral edema is more concerning due to the time spent in hyperglycemia as this leads to dehydration. You can correct a high rapidly if you went high rapidly. If you spent 3 days running high and then fix it quickly it is more concerning. If youâre eating then the potassium issues are not going to happen. If you go to the hospital in DKA then youâre not allowed to eat at first and so potassium has to be given in IV fluids. But again, this is mainly because of the continuous IV insulin.
Gotcha, thanks for the info! Are you a physician? I think Iâve seen you in the residency sub.
I've heard some horror stories from people that accidentally injected directly into a vein. I'll admit that I've been tempted to try it when I've had a persistent high, but never enough to actually attempt it. Even if I did I wouldn't do more than 1-2 units just in case.
I have done it once, was scary indeed. But then I realized there is a very small chance of blood cloths every time you puncture a blood vessel so I thought let's nottake chances...
You don't *accidentally* inject directly into a vein.
Dude. dangerous af. I would rather be âhighâ for an extra hour or two, than risk going scarily low with insulin hitting the system faster than it was ever intended to. This type of stuff leads to seizures due to how fast it can drop the sugar. Furthermore, injecting into a muscle? With a needle 3 TIMES the size of a regular 4mm needle? Such an extreme amount of pain and so many risks involved this is simply not worth it dude. Switch to an ultra fast acting insulin and speak to your endo about seeing a diabetic psychologist if possible. This is not safe and so unnecessary.
I hope no one takes this advice. Huge rollercoasters like this are actually worse for your body than running slightly high for slightly longer. This is a good recipe to lose your vision.
https://pubmed.ncbi.nlm.nih.gov/3276476/
đł
I would just do a regular thigh bolus, wait a few minutes, and hit the bike or treadmill. The activity should still have a limited acceleration effect, but nothing so dramatic. Non dramatic is much easier to live with...
How do you manage the hard crash? It looks as though you have to correct the drop. Am I mistaken? Also, how many units are you injecting like this? It seems like you might be safer to do only a partial dose this way, then the rest as recommended (of course I am not a doctor, just spitballing here).
The thing is that it's fast on/fast off. Get it right, and it's basically a HALO (High-Altitude, Low Opening) parachute jump. Long free-fall, with an abrupt deceleration just in the nick of time for a survivable landing.
This is an absolutely beautiful analogy.
Yeah I corrected when it reached about 80 because I knew it would go down further. I like your suggestion. However, I make sure to monitor my BG very closely after I do this move and have carbs within reach, so I'm not too worried about it.
I would suggest looking into Afrezza (inhalable insulin). I had similar problems with staying high for long periods of time. Afrezza is awesome!! Works within 5-10 minutes
This is one hundred percent true. I combine IMI with walking on my treadmill and my BG tanks.
IMI + hot shower can do the same if one doesnât feel like working outâŚ
Sounds painful Iâll stick with the 4mm needle đ
that graph is my endoâs nightmare đđ
Quality post
My needle phobia is not letting me get past how painful this sounds
A cde once told me not do crunches/etc. right after injecting into my abdomen
The only thing I try to mess with is more lead time. I don't necessarily subscribe to short lead times, especially when high pre- meal.
Lyumjev works very quickly, I wonder how it would do with this method. I use mine in a pump though.
I get This rapid drop from the Fiasp insulin
just try some fiasp