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.