Very high BGL .... thoughts?

  1. 0
    I'm a new LPN (Jan. 2012) and I work LTC. I take care of a patient and his main dx is dementia. He had routine labs drawn and had a BGL over 800 (was never diagnosed with diabetes & is over 75 y/0). He was treated @ the hospital & returned to our LTC facility a week later. He now gets Lantus daily (24 units) & his blood sugars continue to spike up in the 500's with no s/sx of other infection: v/s stable, afebrile, UA negative for infection, LCTA, losing weight (probably d/t elevated BGL). Any thoughts/advice?
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  3. 25 Comments so far...

  4. 0
    Not wanting to sound rude, but just be sure the MD is aware. It isn't our job to medically manage patients.

    Also, he probably needs some lifestyle modification and a sliding scale.
  5. 0
    Just because he's a symptomatic now doesn't mean he will stay that way. Sounds like he needs a DKA workup or an insulin regimen change. Regardless he is at a higher risk for infection, stroke, MI, Etc as well as all the micro complications r/t uncontrolled diabetes.
  6. 2
    The elderly are more prone to HHS -- hyperosmolar hyperglycemic state -- the slower, the less acute, type II equivalent of type I DKA. Although the first crisis seems to have been resolved with the trip to the hospital, current treatment regimen is obviously not adequate. The danger of HHS is severe dehydration and altered mental status, leading to coma. Like mentioned already, be sure the MD is aware. At LTC I worked in the past, we always had the protocol to notify MD for BGL>400. For LTC residents, physicians often wouldn't know what's going on with them unless the nurses called them. It might be helpful if you faxed to the MD the monthly or weekly BGL trend together with current MAR.
    tigerlogic and Esme12 like this.
  7. 0
    The MD is most definately aware and has been called almost daily with updates. In fact, I called yesterday twice d/t the high levels, outside of the sliding scale parameters. The Lantus has been changed from 20 units to 24 units, to now 28 units. He is having a CMP with diff & a BMP today, agian. I know how to manage someone with high/low blood sugars. I know I don't diagnose but I was just curious if someone else saw something like this & the patient had something underlying more serious than a UTI or easily explainable infection, as this patient has nothing obvious that the MD or nurses can detect. Hopefully, more tests can find the underlying cause or the MD will get the diabetes managed. (one last note: we have a NP who is avaliable Mon-Fri, she has seen him and reviewed his BGL's almost daily & she works with his MD, too).
  8. 1
    Is he perhaps, actively dying? It seems his pancreatic islets cells have "given up"? Is this not the time to consider CMO?
    KitkatPRN likes this.
  9. 0
    Has he been worked up for pancreatic cancer?
  10. 1
    He is not getting enough meds. Period. Talk to MD
    michelle126 likes this.
  11. 0
    Why are you sure that he has an infection?

    Also, agree with classicdame.
  12. 1
    classicdame is right on. One thing you can do is make sure the patient gets plenty of water. Will help him feel better and keep the kidneys flushed of all that extra glucose they're cleaning up.
    KitkatPRN likes this.


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