Question on Pediatric Insulin Administration

to begin with - the ADA and the Am. College of Clinical Endocrinologists published a position statement a few years ago that stated SSI is "non-effective and not recommended". The preferred method is basal plus correction doses of fast-acting. There should be a nursing protocol for that on your unit. If not, you need to find one and find the science behind it to get a new P&P written. The Academy of Pediatrics, ADA and others will have samples. The Medical staff has to approve, of course. You are right, it is ridiculous to make patients wait. I suspect this is a teaching hospital and someone thinks this is how the resident keeps tabs on diabetics, but in reality the patient is not being served and the resident is making shotgun decisions. Recipe for disaster.

Our patients WAIT.

Only the on-call endocrinologist can make the dosing decision. This is because the carb-ratio and correction factor is different for each child and is often adjusted q dose.

I really can't imagine standing orders for insulin in pediatrics.

So, the nurse pages the intern with the blood sugar, ketones, and carb count. The intern must then page the endo; after they discuss, the intern enters the order and the nurse can proceed.

In almost 2 years of acute care pediatrics, I have never had a "known" diabetic peds patient. They've all been newly dx or dka. I'm sure there are such pts, but we have a 30+ bed unit, so they must be pretty rare.

In talking with our endo, I would venture that the stable, well-controlled ped diabetic pt is a fairly rare species, anyway. Kids are always changing. Even if they were otherwise controlled, coming in for surgery would most certainly require changes from their normal home regimen. The stress of surgery alone is likely to require higher insulin doses, not to mention interference of any meds (such as steroids for asthma, etc).

Just speaking from my own experience.