Definition
Injections of plain insulin in increasing doses to produce hypoglycemia of varying depths with the intention of achieving the repression of symptoms.
Indications
- Depression.
- Neurotic illness.
- Withdrawal behavior.
- Psychosomatic illness.
- Schizophrenia.
Contraindications
- Pregnancy.
- Recent myocardial infarction.
- Diabetes mellitus.
- Systemic diseases involving heart, lungs and kidneys.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Explain to patient and family, the details of therapy and how he may participate. | Client and family gains knowledge of the therapy and cooperates. |
| 2. | Obtain informed consent from patient and/or family. | Avoids legal issues related to the therapy. |
| 3. | Provide an ID Card for client to carry with him/her if therapy is planned on an out-patient basis. | 3-6 treatments per week are generally given. |
| 4. | Instruct client to starve overnight and not to have breakfast in the morning of therapy. | Keeps blood glucose at a lower level. |
| 5. | During procedure Administer 5 units of soluble insulin on the first day at 7 am. Insulin dosage is increased every day/every therapy by 10 units to an average dose of 100 units. Maximum dose is 300 units. | Produces a hypoglycemic state. |
| 6. | Observe the client for manifestations of hypoglycemia and monitor vital signs every 15 minutes. | Ensures client’s well-being. |
| 7. | Assess the client periodically during the therapy. | Checks for the level of repression achieved. |
| 8. | Therapist carries out therapeutic communication with client as he reacts to the hypoglycemic state. | |
| 9. | Terminate the treatment at 10 am. (after three hours) by administering 25% glucose orally or intravenously. | Reverses hypoglycemia. |
| 10. | After procedure Serve breakfast after half an hour of termination of therapy. | Helps blood glucose to return to normal levels. |
| 11. | Instruct family/relatives to continue to observe the client for manifestations of hypoglycemia following therapy. | With increasing insulin dose, deeper hypoglycaemia may occur, requiring close observation for longer period. |
Special Considerations
- Ensure informed consent is obtained, explaining the risks, benefits, and purpose of the therapy.
- Conduct a thorough medical assessment, including blood glucose levels, cardiovascular health, and neurological status.
- Verify the patient’s NPO (nothing by mouth) status to prevent complications during therapy.
- Administer insulin under strict medical supervision, ensuring the correct dosage and timing to induce a controlled subcoma state.
- Monitor for adverse reactions, such as hypoglycemia or seizures, and be prepared to intervene promptly.
- Maintain continuous glucose monitoring to ensure patient safety.
- Ensure proper oxygenation and airway management in case of complications.
- Observe the patient for side effects, such as confusion, headache, or fatigue.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
- Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
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