Is a blood glucose of 455 ever "normal"?

  1. 0
    Just wondering if you get a reading like this do you panic? Re-test with a new machine? I was calm and cleaned the residents hands and switched machines. Just wondering as I do not know this resident but the regular nurse (ltc) agreed that I did the correct things but that the residents sugar is usually really high, like in the 300's.

    The resident is on three insulins: the two I can remember off the top of my head are Novolin and Novolog. I only gave the Novolin (routine insulin with sliding scale given as ordered) but I was just scanning her Mar to see what else she was on. She was on a sliding scale and the rest of the day her tests were 155 and 130.
    Last edit by gatoraims RN on Nov 6, '11 : Reason: typos
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  3. 18 Comments so far...

  4. 0
    Re-test w/ a new machine, or run the QC on the one you're using, then re-test the pt.

    Novolin (whether R, NPH, or 70/30) with Novolog and something else(?!) seems a bit odd to me. Not questioning the doc or you, per se, but with one of the -logs (ultra-fast acting) I would expect her to be on a constant basal with Lantus, or similar. Speaking as a 37+ year DMI, myself...
  5. 0
    For one of my brittle diabetics it was "normal" to see that high of a reading. Didn't make me panic (I learned quick from talking with the other nurses who card for her and after seeing her number to realize she was up and down and all over the place most days). I just would recheck the QC, then recheck her again. Then report it to the supervisor, check the MAR for the sliding scale and call the doc as per the order.
  6. 0
    You did the right thing to wash her hands and retest. With extra food or not enough insulin a 455 blood sugar can happen. Hope the staff was knowledgable enough to bring the patient's blood sugar back down.

    Novolin 70/30 is a mix of long and short acting insulin. It is sometimes used to provide the basal (base) rate of insulin for patients on injections. Takes a few hours to lower blood sugars substantially.

    The Novolog is a fast acting and begins working in 15 min. and is out of the system within 2-4 hours. There's a good book called "Using Insulin" by John Walsh that you may find useful.
  7. 0
    Quote from Rob72
    Re-test w/ a new machine, or run the QC on the one you're using, then re-test the pt.

    Novolin (whether R, NPH, or 70/30) with Novolog and something else(?!) seems a bit odd to me. Not questioning the doc or you, per se, but with one of the -logs (ultra-fast acting) I would expect her to be on a constant basal with Lantus, or similar. Speaking as a 37+ year DMI, myself...

    Thanks, I will have to look at her MAR the next time I am on that wing. I work the 7-3 and it might be that Lantus or other insulin is given prior to or after I get on the floor. I could have over looked it or it is just not fresh in my memory. Novolog and Novolin where the ones that were scheduled for the shift I was working. So I remembered those two.

    I really need to break out the books and re-educate myself. The endocrine system was for me the hardest to grasp.

    Quote from CT Pixie
    For one of my brittle diabetics it was "normal" to see that high of a reading. Didn't make me panic (I learned quick from talking with the other nurses who card for her and after seeing her number to realize she was up and down and all over the place most days). I just would recheck the QC, then recheck her again. Then report it to the supervisor, check the MAR for the sliding scale and call the doc as per the order.

    The sliding scale did not have us calling the doc until it was over 500. I have never seen an order written like that. Most the orders I have ran across have you calling when it is between 430 or over. That is what sorta made me question myself. It is a new world when you read "text book perfect" situation vs real life situations.


    Quote from CDEWannaBe
    You did the right thing to wash her hands and retest. With extra food or not enough insulin a 455 blood sugar can happen. Hope the staff was knowledgable enough to bring the patient's blood sugar back down.

    Novolin 70/30 is a mix of long and short acting insulin. It is sometimes used to provide the basal (base) rate of insulin for patients on injections. Takes a few hours to lower blood sugars substantially.

    The Novolog is a fast acting and begins working in 15 min. and is out of the system within 2-4 hours. There's a good book called "Using Insulin" by John Walsh that you may find useful.

    Thanks so much I am going to look for that book. I love to read and insulin is something I can use more educating in. I know the basics but get so mixed up with them.

    Her blood sugar was going down prior to my leaving and when I spoke with the nurse who was on the 3-11 said that it ranged from the high 100's to 250 while she was on.


    Thank you so much for all your tips, I hope to get to a point that I know I did the correct thing and it just because natural to know what to do in a situation.
  8. 0
    Our sliding scale insulin orders all read <60 or >400 notify the doctor. Which for this particular patient meant a call to the doc at least once a day..ughh
  9. 1
    455 bs is only normal for people wanting to see how long it takes to stroke out

    Meds need to be reviewed. If she is not being controlled then regimen needs to be changed. Period.
    delphine22 likes this.
  10. 0
    Quote from classicdame
    455 bs is only normal for people wanting to see how long it takes to stroke out

    Meds need to be reviewed. If she is not being controlled then regimen needs to be changed. Period.
    I know, but continuing care is a series of long, involved progress notes. Death is a single packet.

    You are absolutely correct, but many docs aren't comfortable/proficient enough (nor are many nurses) to actively work serum glucose into a consistant theraputic range.
  11. 0
    I like the fact that we use a sensitivity factor to dose novolog instead of a normal sliding scale. The sensitivity scale is based on the weight of the patient in kilograms. This is divided by 3000. The patient who has a weight of 100 kg would have a sensitivity factor of 30. Then the 400 bs-110=380/40 gives the amount of novolog the patient is to receive. This is done q 2 hours until the patient has a blood sugar under 200. Seems to work well.
  12. 0
    there are guidelines to educate MD/nursing on how to manage hyperglycemia for every setting: acute, at home, etc

    See www.diabetes.org and www.guidelines.gov

    Sounds like people are passing the buck waiting for someone else to make a decision


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