How to avoid hypoglycemia during 12 hour shifts? - page 2

by Hoozdo

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Question for other diabetic nurses - Do you take your insulin and/or hyperglycemic agents at work? I find that I can't or I will go hypoglycemic and it ain't pretty! I work ICU and I really don't have the luxury to eat at a... Read More


  1. 0
    Quote from Hoozdo
    Well, I just got home from work and glucose is my predictable 98 on my usual food with no glyburide. Your post is extremely helpful to me. I am on glyburide because my transplant center told me (7 years ago) that it is the only hyperglycemic that is easy on the liver.

    I am thinking now that I probably need an endocrinologist appt. Your drug suggestions are certainly things I can suggest.
    Thanks
    PS - dose of glyburide is 10 mg BID. I can't take any within 24 hours of working or I will go hypo. It is easier to deal with insulin than what I am doing now....which is basically starving to control my glucose at work!
    The new drug, Januvia, has no contraindications or dose adjustments based on liver function. Dose is 100 mg daily taken without regard to meals. Also can be used it pts with renal failure (reduced dose). Action of Januvia is glucose dependent, so will not produce hypoglycemia. This might be a good drug for you.

    Your glyburide dose is max allowable dose. Dose can be as low as 1.25 mg up to max of 20 mg/day. Rx info from PDR states can be given once daily for doses up to 10 mg/day. Higher doses can be divided and taken with breakfast & dinner. My question is if you have had low BG, why are you on max dose? Why couldn't you take 2.5mg, eat breakfast, and go to work Does have note to give at lower dose with decreased renal or hepatic function (similar statement is in PDR info for Actos).

    Insulin is actually more flexible than oral antihyperglycemics. Dose can be adjusted in very small increments depending on ac BG and amt of carbs in meal. Best would be Humalog, Novolog, or Apidra before meals and Lantus at bedtime. But there are more choices (of po meds) available to you other than glyburide. Check BG 2 hrs after start of meal to assess response to meal.

    Have you always been so thin? Was any wt loss related to very high BG at some time in the past (onset of DM, for example)? Is it hard for you to bring food from home (fruit, cheese & crackers or pita bread, 1/2 sandwich or yogurt? You certainly owe yourself a more healthful, less restrictive diet!

    Good luck
  2. 0
    Quote from futurenurse35
    the important thing is to use the glycemix index. low glycemic carbohydrates enter the bloodstream slowly and are best eaten before exercise. they provide sustained longer-term energy, and help maintain stable blood sugar levels during extended periods (greater than one hour).

    [color=#330000]the glycemic index
    [color=#330000] all carbs are not created equal!
    [color=#330000]for a healthy low carb or low glycemic lifestyle.
    [color=#330000]the lower the glycemic index a food, the less it will cause insulin surges (and weight gain). here is our list of commonly eaten foods, compiled from several glycemic indexes. on this index, glucose is the benchmark of 100. to control your carbs, choose foods at 50 - 60 or below whenever possible. if you are new to a low carbohydrate diet or a low glycemic diet, stay below 30 for the first two weeks, then add carbohydrates that are higher on the index gradually, until your weight loss stops. that way, you will be able to see which carbohydrates are safe for you! we are all different and react differently to various foods. *

    if you need more help, you may send me a pm.....i will be more than happy to help

    the glycemic index has gone in and out of vogue over the years. looking for the low gi isn't always the answer. for example, chocolate cake with chocolate frosting has a gi of 38. a twix bar is 43. the theory is that the fat in these foods causes the a delay in the absorption of the carbs. so if you want a baked potato which has a gi of 94, put lots of butter on it to lower the gi.
  3. 0
    Quote from myxel67
    the new drug, januvia, has no contraindications or dose adjustments based on liver function. dose is 100 mg daily taken without regard to meals. also can be used it pts with renal failure (reduced dose). action of januvia is glucose dependent, so will not produce hypoglycemia. this might be a good drug for you.

    januvia sounds like a great choice. i will speak with my doctor about it!

    your glyburide dose is max allowable dose. dose can be as low as 1.25 mg up to max of 20 mg/day. rx info from pdr states can be given once daily for doses up to 10 mg/day. higher doses can be divided and taken with breakfast & dinner. my question is if you have had low bg, why are you on max dose? why couldn't you take 2.5mg, eat breakfast, and go to work does have note to give at lower dose with decreased renal or hepatic function (similar statement is in pdr info for actos).

    i only take the glyburide on days off when i don't have much physical activity!

    insulin is actually more flexible than oral antihyperglycemics. dose can be adjusted in very small increments depending on ac bg and amt of carbs in meal. best would be humalog, novolog, or apidra before meals and lantus at bedtime. but there are more choices (of po meds) available to you other than glyburide. check bg 2 hrs after start of meal to assess response to meal.

    i have been on/off insulin ever since my transplant. there was about a 2 year period in which i needed no hyperglycemic agents.

    have you always been so thin?
    no, only since i started nursing last january and running my butt off
    was any wt loss related to very high bg at some time in the past (onset of dm, for example)?
    no. the onset of my diabetes began with my liver transplant. at first it was believed it was due to solumedrol/prednisone use only. i was weaned off all steroids and the diabetes continued. it is a side effect in 20% of patients that take prograf (fk506, tacroliminus) for an immune suppressant!

    is it hard for you to bring food from home (fruit, cheese & crackers or pita bread, 1/2 sandwich or yogurt? you certainly owe yourself a more healthful, less restrictive diet!

    good luck
    thank you for all of your comments. you have been very helpful to me!:kiss
  4. 0
    I was dx with type 2 just last week with an A1C of 7.7. Of course, I had to check my own fasting & 2hpp just to convince myself of the dx. I've not yet started the metformin, but glad to know that it won't cause hypo-g. That is my biggest immediate fear.
    Does anyone use a pda resource to manage diet? Is counting carbs the best way to go?
  5. 0
    Quote from vickynurse
    I was dx with type 2 just last week with an A1C of 7.7. Of course, I had to check my own fasting & 2hpp just to convince myself of the dx. I've not yet started the metformin, but glad to know that it won't cause hypo-g. That is my biggest immediate fear.
    Does anyone use a pda resource to manage diet? Is counting carbs the best way to go?
    Sorry, just realized this question should go on another thread. Good luck to you.


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