There is some discussion about our practice of checking AC fingerstick at 6:00 AM. In our hospital, meal trays arrive at around 8:00-8:30 AM for breakfast. How close to mealtime should we check BG? Will there be a significant change of BG levels two hours after checking it? If there's a coverage, who should give it (the nightshift RN or the dayshift RN).Is there an evidenced-based practice regarding the right timing and frequency of BG monitoring or nurses just follow the hospital norm?
Jun 25, '12
With pediatrics, we do correction factors and carb counting. We check finger stick immediately before they eat to obtain the baseline glucose for the correction factor calculation. Then we give additional insulin based on their carb ratio. If the child is old enough to tell us what they will eat, we give the insulin right before they start eating. If they are young and don't know what they will eat, then we give them a half hour time window to eat the meal and give the insulin as soon as they are done eating.
Jun 25, '12
Quote from Ashley, PICU RN
. Then we give additional insulin based on their carb ratio. If the child is old enough to tell us what they will eat, we give the insulin right before they start eating.
Thanks Ashley...we give insulin based on a sliding scale prescribed by MDs and not by I:C ratios.
Jun 26, '12
Sliding scales are less than useless. If you are using Regular insulin (which I assume to be the case), the 0600 FS will give you a baseline for correction at mealtime, but is meaningless w/o a meal bolus ration. Translation: 0600 FS is 209, so you have 2 units of Regular ordered. Great. That will correct the 209, but does nothing to process the food being eaten at 0800. The next FSBS (I'm assuming 1000) is a shot in the dark, as the BS is on its way up, and the Reg is running out of steam. Docs don't like getting paged for acute hypoglycemia, and hospitals don't like paying staff to monitor as closely as is required.
Hospital policy rules the day, but one of the DNEs here should be able to send you towards one of numerous articles demonstrating that improved glycemic control (non SS) decreases M&M.
Jun 26, '12
"The next FSBS (I'm assuming 1000) is a shot in the dark, as the BS is on its way up, and the Reg is running out of steam. Docs don't like getting paged for acute hypoglycemia, and hospitals don't like paying staff to monitor as closely as is required."
[FONT=franklin gothic medium]Thank you, Rob72...this is exactly our problem and it's even worse since we are also using Novolog which is supposed to be given 15 minutes prior to meal.
Jun 27, '12
What astounds me is the screaming impetus for treating the "diabetic epidemic", but an utter lack of use, and training on, the insulin pump.
There is no reason that an inpatient could not have the sub-q cath placed, and use a simple (theft)alarm-equipped pump. Equally, as the sub-q glucose sensors evolve, there is also no valid reason not to have them wi-fi-ed to a central monitor, as we do in cardio, for real-time monitoring.
Also, while it might be "hard-core", the DON should be challenging the use of SS and BID FS orders and the use of Novolog/Humalog in relation to standards of care.