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A doctor has admitted at a medical tribunal that an incorrect insulin dose entry she wrote for an elderly diabetes patient, at a hospital in Edinburgh, would have been suitable for a diabetic elephant. Doctor Lucy Mahinda told the tribunal that the dose which the patient, aged 87, should have received was around 4 units of insulin but Dr Mahinda had written out 38 units, around 10 times too much, as the dose to be administered.
Fortunately, the error was spotted by a nurse before the insulin dose, which could well have proved to be lethal, was given to the elderly woman under the hospital's care. Dr Mahinda, admitted that the insulin dose she had advised would have been a huge overdose and referred to it as being "a dose for an elephant".
The doctor, who works at Western General Hospital in Edinburgh, may face suspension or being struck off the medical register if the tribunal finds her to be unfit to practise. Find support, ask questions and share your experiences with 209,001 members of the diabetes community. 10 week (free) low-carb education program developed with the help of 20,000 people with T2D and based on the latest research. The first comprehensive, free and open to all online step-by-step guide to improving hypo awareness.
If caught in time though hypoglycemia, or insulin overdose, can be reversed without causing permanent damage.
The Tox Cave will dissect interesting ED cases from the perspective of a toxicologist, focusing on applying up-to-date management of the poisoned patient. The name Tox Cave was coined by a former toxicology fellow to describe our small office space, likening it to the Bat Cave. This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. Please note that we are unable to respond back directly to your questions or provide medical advice. Welcome back to our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.
Today, our D'Mine columnist and correspondent Wil Dubois takes a real close look at an essential component of our health that most of us never think about. If we had a dollar for every time "What the heck??" was uttered in managing diabetes, we'd probably have enough funds to find the cure ourselves!
Thanks for the helpful information, I have been a diabetic who has recently been having some dry skin issues and this post really helped me to see what was wrong.
For dry skin on feet try Bag Balm in a green tin--it has done wonders for my dry and crack prone feet! I'm a bit late to this, but for the dry skin:Bag Balm can be amazing, but painful if you have neuropathy. As the fastest growing consumer health information site a€” with 65 million monthly visitors a€” Healthlinea€™s mission is to be your most trusted ally in your pursuit of health and well-being. An insulin overdose is not uncommon, as it's not difficult for too much to be injected into the body by accident. When the sun rose that morning, I was in the kitchen as usual with my daughter, preparing to take my insulin. By having high up levels of glucose in your blood kindle the human cells of the pancreas to add to the quantity of insulin added into your blood.
It’s the point at which there is so little sugar to fuel your brain that your body can no longer function properly. In addition to the incorrect dose being advised, the type of insulin specified was also incorrect and during the same shift Dr Mahinda had prescribed 10 times as much of the antibiotic nitrofurantoin to an 84 year old patient.
She admitted that the medication error had been "very weird" and "very serious" and added her regret that she had made such an error.


The Tox Cave is where Drexel toxicology fellows and attendings have gathered to discuss the nuances of toxicology over the years. Welcome back to Ask D'Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois.
Both of which will support, guide, and inspire you toward the best possible health outcomes for you and your family.
Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit. When there is a deficiency of insulin in the body, the dog is diagnosed with Diabetes Mellitus. And luckily, knowing and noticing the symptoms enables you to take quick action to bring your blood sugar up to a safe level. The former is the most prevalent type (99% of dogs with DM suffer from this type) and occurs when the body doesn't produce enough insulin. The latter occurs when insulin is manufactured but your pooch's body isn't able to use it properly. Renal toxicity is associated with the precipitation of methotrexate and its metabolites in the renal tubules causing acute tubular necrosis. Toxicology was consulted regarding management.The National Poison Data System collected data between 2013 and 2014 for more than 62,000 children under 6 who were exposed to laundry and dishwasher detergents. My question that I haven't found an answer toA yet: It's obvious why BG rises in a type 1 -- lack of insulin to help it get into the cells and out of the bloodstream.
Most reported toxicity occurs with chronic oral administration, but other routes of reported toxicity include inadvertent high-dose intrathecal, intravenous, and intramuscular administration. Toxicity is possibly multifactorial and possibly dependent on specific brands and formulations. Why can't the natural mechanisms of the body kick in (is glucagon the only mechanism at play?) to keep a diabetic from going low, as happens with non-diabetics? Chemical arachnoiditis may present with fever, headache, meningismus, paraplegia, and seizures. One component, propylene glycol, is metabolized to lactate and contributes to the transient elevation of serum lactate and metabolic acidosis. Chronic leukoencephalopathy presents with behavior disturbances, dementia, and coma.What is the diagnostic testing for patients suspected to have methotrexate toxicity??Serum methotrexate levels are useful, but results may not be rapidly available. Ethoxylated alcohols, a class of non-ionic surfactants, are associated with the vomiting, diarrhea, and lethargy after ingestion.Laundry pods can deliver significantly higher concentrations of detergent when the casing is broken, as occurs upon biting the water-soluble casing. Other useful tests to evaluate for toxicity include creatinine, complete blood cell count, liver function tests, and chest radiography.
The incidence of ingestion is likely higher because their appealing appearance leads children to mistake them for candy.The clinical effects are self-limited, and management is mostly supportive in most cases. In patients with signs of neurotoxicity, MRI of the brain and CSF analysis to evaluate for infection should be considered.What are antidotal strategies for methotrexate toxicity?Leucovorin (folinic acid) should be administered in patients at risk for or with signs of methotrexate toxicity. Assessment of the airway is important for patients presenting with signs of respiratory distress or aspiration. Folinic acid is the reduced active form of folate, and it does not require DHFR, an enzyme blocked by methotrexate. Patients should also be closely observed for profound CNS depression and should be assessed for airway protection.
Folic acid is unable to counteract the effects of methotrexate.Dosing of leucovorin after an overdose should approximate the same plasma concentration as the methotrexate. It is important not to underdose the leucovorin: It is safe, and methotrexate is very toxic. A chest radiograph should be obtained in these cases because of the risk of aspiration pneumonitis.Dermal decontamination should be initiated with removal of contaminated clothing and thorough irrigation with copious amounts of water to prevent development of significant chemical burns. Gastric decontamination with activated charcoal is not recommended given the potential risk for aspiration with vomiting and CNS depression.Endoscopic evaluation may be considered in patients with suspected significant caustic injury. These patients may present with persistent vomiting, drooling, difficulty or aversion to swallowing or eating, and abdominal tenderness.


Though these criteria are not 100% sensitive for caustic injury, children who are asymptomatic and able to tolerate PO do not need endoscopic evaluation and can be safely discharged after observation.Our patient was observed in the emergency department without further episodes of emesis. The sugar-normal's pancreas mainlines insulin straight into the blood stream via the rather large portal vein. Allergic or anaphylactoid reactions have been reported.Glucarpidase (carboxypeptidase G2) is available on a compassionate use basis in the United States. On the other hand, those of us using our primitive pumps, pens, and syringes are shooting into the layer of fat between our skin and muscle.
Sure, the insulin gets taken up by the blood system, but it takes quite a while for that to happen. It works by hydrolyzing methotrexate to inactive metabolites via IV or intrathecal administration. His parents were educated regarding potential dangers of laundry detergent pods and toxic exposure prevention.Suggested ReadingsSmith E, Liebelt E, Nogueira J. Significant bone marrow suppression may be treated with granulocyte colony-stimulating factor and blood transfusions, and the case is ideally managed with a hematologist.
That's because despite our very best efforts at carb counting, insulin tracking, paying attention to our level of exercise and stress, even on a good day we're basically using stone knives and bear skins to try to build a space station. Our best technology falls woefully short of the elegance of the properly functioning human body.As for the body's response to insulin, several factors are at play. Leucovorin therapy was started as well, and the patient was admitted to the ICU for frequent neurologic checks. First off, in the absence of an artificial source of extra insulina€”such as an injection of insulin manufactured in an Eli Lilly plant, or a medication designed to increase insulin productiona€”it's unlikely your pancreas would produce much more insulin than needed. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. A repeat methotrexate level the following day was negligible and undetectable the day after that. Case Files of the New York City Poison Control Center: Antidotal Strategies for the Management of Methotrexate Toxicity. Glucagon, either the body's own, or from an emergency kit purchased at Rite Aid, is simply a means to an end.
So the body's internal defense mechanisms can't keep up.Secondly, in those of us with type 1, the response to hypos gets blunted. If the whole glucagon, glycogen, glucose thing isn't doing the trick and blood sugar is still falling, the kidneys try to ride to the rescue, and the body cuts loose with the sugar-rich epinephrinea€”the body's natural Red Bulla€”to give you wings. Actually, if you "feel" a low, what you're feeling isn't the low blood sugar, or the glucose release from the liver.
So when you feel the symptoms of a low, Plan A has already failed.And of course both Plan A and Plan B often aren't enough. The body simply isn't equipped to deal with an overdose of insulin that lasts 24 times longer than evolution built it for.
Arguably, an equally tragic event.Of course, visit your doc to ensure that you don't have some funky fungus or yeast that might be making the drying worse.
But then, here's my last-ditch advice: When you go to bed, slather your feet with Vaseline and then cover your feet with socks.
Your skin will bask in healing moisture all night.You'll probably need to do it for a number of days, maybe even for a full a week at first.
After that, hopefully just now and again.Oh, and be careful when you take them off in the morning. We are PWDs freely and openly sharing the wisdom of our collected experiences a€” our been-there-done-that knowledge from the trenches.



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