Insulin Coma Therapy 1930-1955
Used in the treatment of patients with manic depression or schizophrenia:
Patient receives no breakfast and administer insulin subcutaneously at 7am. Initial dose 30-40 units, increase by 10-20 units until shock dose is reached. Use the shock dose six mornings a week until a full course of 50 shocks is reached. Leave patient in bed in quiet dark room to promote sleep. After about an hour the patient begins to perspire, and then profusely. After the second hour there may be restlessness and restraint may be necessary. Consciousness is lost and patient is non-responsive. The eyes roll and patient salivates. Turn him face down to promote drainage. Closely monitor pulse and respirations: breathing is deep and noisy and pulse is full and rapid. Near the end of the third hour the patient will go into a full coma, without a corneal reflex. The patient is flushed and soaking wet. Monitor temperature as falls to 92 degrees F; keep warm. Once the patient is in the coma, administer sugar syrup by nasalgastric tube. Give 4-5 oz. Seizure may occur- place gag in mouth and give 1 cc of adrenaline to bring the patient out of shock, follow with intravenous glucose. Patient will respond to syrup within 20 minutes. They will be weak, confused, and unsteady for the following hour or more When fully alert, have patient dress and keep active. This treatment requires rigid adherence to the routine and nursing alertness at all times. Death can occur. Improvement usually begins after one week of shocks. Weight gain occurs.
From V. M. Tipliski Parting At The Crossroads: The Development of Education for Psychiatric Nursing in Three Canadian Provinces 1909-1955.
Patient receives no breakfast and administer insulin subcutaneously at 7am. Initial dose 30-40 units, increase by 10-20 units until shock dose is reached. Use the shock dose six mornings a week until a full course of 50 shocks is reached. Leave patient in bed in quiet dark room to promote sleep. After about an hour the patient begins to perspire, and then profusely. After the second hour there may be restlessness and restraint may be necessary. Consciousness is lost and patient is non-responsive. The eyes roll and patient salivates. Turn him face down to promote drainage. Closely monitor pulse and respirations: breathing is deep and noisy and pulse is full and rapid. Near the end of the third hour the patient will go into a full coma, without a corneal reflex. The patient is flushed and soaking wet. Monitor temperature as falls to 92 degrees F; keep warm. Once the patient is in the coma, administer sugar syrup by nasalgastric tube. Give 4-5 oz. Seizure may occur- place gag in mouth and give 1 cc of adrenaline to bring the patient out of shock, follow with intravenous glucose. Patient will respond to syrup within 20 minutes. They will be weak, confused, and unsteady for the following hour or more When fully alert, have patient dress and keep active. This treatment requires rigid adherence to the routine and nursing alertness at all times. Death can occur. Improvement usually begins after one week of shocks. Weight gain occurs.
From V. M. Tipliski Parting At The Crossroads: The Development of Education for Psychiatric Nursing in Three Canadian Provinces 1909-1955.