Was I wrong to hold Insulin? Was I wrong to hold Insulin? | allnurses

Was I wrong to hold Insulin?

  1. 0 I had a bood sugar check of 75 during the 5:30 check. I was supposed to give 6 units of Novolog and there was no hold order in the MAR. I consulted 2 other Nurses on the floor who agreed the blood sugar was too low and I held it. This is an elderly lady with an unreliable appetite. Later on in the evening I went and checked her blood sugar again and it was 133. (was I even wrong to recheck? mabye) The next time I went into work the care manager for the unit told me that I should have called the Dr if I was going to hold her insulin for under 100. She also said that I should have given her regular Novolog and given her a milk shake. What if she wont drink the milkshake? I dont have time to chase 7 Diabetics all over the place watching everything they eat and drink. I did the check when I was supposed to and it was low, so I held it. What do you think?
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  2. 21 Comments

  3. Visit  eatmysoxRN profile page
    #1 1
    I would have held it as well. Always follow policy though.
  4. Visit  hodgieRN profile page
    #2 0
    I am assuming that there was an order to give 6 units of insulin regardless of the blood sugar and not simply a sliding scale. Endocrinologists will write orders for insulin on top of the sliding scale insulin for patients for resistance. At my hospital, any insulin that is held needs doctor approval, but that's for Levemir or base coverage. If it was a sliding scale, I wouldn't have given insulin for a blood sugar level of 75, but there is a "did not meet criteria" option. I don't get the idea of giving milk for hypoglycemia and then give them insulin. Doesn't that defeat the whole purpose? If you need to give carbohydrate coverage to off-set impending hypoglycemia, why give the insulin? But I do know that any insulin orders that do not specify holding it for anything under a certain range, there needs to be an order from the doc.
  5. Visit  FLmed profile page
    #3 0
    Quote from hodgieRN
    I am assuming that there was an order to give 6 units of insulin regardless of the blood sugar and not simply a sliding scale. Endocrinologists will write orders for insulin on top of the sliding scale insulin for patients for resistance. At my hospital, any insulin that is held needs doctor approval, but that's for Levemir or base coverage. If it was a sliding scale, I wouldn't have given insulin for a blood sugar level of 75, but there is a "did not meet criteria" option. I don't get the idea of giving milk for hypoglycemia and then give them insulin. Doesn't that defeat the whole purpose? If you need to give carbohydrate coverage to off-set impending hypoglycemia, why give the insulin? But I do know that any insulin orders that do not specify holding it for anything under a certain range, there needs to be an order from the doc.
    Agree!!!!
  6. Visit  classicdame profile page
    #4 2
    this is called nursing judgment. If your clinical assessment does not match the intent of the order you are to notify the MD. I think you did the right thing.
  7. Visit  Anne36 profile page
    #5 4
    There is now an order in the MAR to hold if the blood sugar is under 100. Im glad that has been cleared up
  8. Visit  victorcr profile page
    #6 4
    I would have held it as well. However, to cover yourself notify a MD and document.
  9. Visit  MelanieND profile page
    #7 5
    Quote from Anne36
    I had a bood sugar check of 75 during the 5:30 check. I was supposed to give 6 units of Novolog and there was no hold order in the MAR. I consulted 2 other Nurses on the floor who agreed the blood sugar was too low and I held it. This is an elderly lady with an unreliable appetite. Later on in the evening I went and checked her blood sugar again and it was 133. (was I even wrong to recheck? mabye) The next time I went into work the care manager for the unit told me that I should have called the Dr if I was going to hold her insulin for under 100. She also said that I should have given her regular Novolog and given her a milk shake. What if she wont drink the milkshake? I dont have time to chase 7 Diabetics all over the place watching everything they eat and drink. I did the check when I was supposed to and it was low, so I held it. What do you think?
    As a Diabetes Educator, you were right to hold the six units. Be proud of your self for using your nursing judgment. It is true that you must follow policy, but you have a brain too. The only thing I would correct, a patient is not a diabetic, a patient is a human who has diabetes. As medical professionals, we treat human beings not conditions. Please don't call them by their diagnoses or condition. Thank you for doing the right thing.
  10. Visit  mammac5 profile page
    #8 3
    Appropriate to hold the insulin in an elderly patient with CBG of 75 but if your institutional policy says you must notify the prescriber when you judge that the insulin should be held, then you should follow that policy.

    Giving the insulin and then offering the patient a milkshake would frustrate the CRAP out of me, as a prescriber! What is the point of that? Why would anyone give a milkshake to a diabetic patient? Sheesh.
  11. Visit  turnforthenurse profile page
    #9 1
    I would have held it; however, make sure you follow your facility's policy. Where I work, we have a standing order to hold all pre-prandial insulin if the blood sugar is </70 but we still need to notify the doctor. We ALWAYS need a doctor's order to hold insulin and this needs to be documented. A patient's blood sugar may be 82 so they may not get coverage but they may have some Lantus scheduled...say, 20 units at bedtime. We still need to call the doctor to see if they want us to hold it or at least adjust the dose. You also weren't wrong to recheck the blood sugar; I would have done the same thing, especially if the patient has an unreliable appetite.
    Last edit by turnforthenurse on Dec 5, '12 : Reason: typo
  12. Visit  ohellemarie profile page
    #10 1
    Thanks Anne! great answer. As a nursing student with type 1 diabetes I am tired of being known as the "diabetic". Nice to know other people are aware
  13. Visit  pussNbootsDolly profile page
    #11 0
    Quick question!!

    I understand you DO NOT HOLD Lantus for a Blood Sugar of 59.

    What about Humulin N ? It is scheduled at 44 units Q am in the wee hours (6:00 am).

    Can I simply just Hold Humulin N, chart it as such and tell the oncoming nurse, or do I need to call the Doctor at 6 AM/
  14. Visit  Sun0408 profile page
    #12 1
    Quote from pussNbootsDolly
    Quick question!!

    I understand you DO NOT HOLD Lantus for a Blood Sugar of 59.

    What about Humulin N ? It is scheduled at 44 units Q am in the wee hours (6:00 am).



    Can I simply just Hold Humulin N, chart it as such and tell the oncoming nurse, or do I need to call the Doctor at 6 AM/
    Do you not have a hypoglycemic protocol to follow?? I know with all our DM pts or any pt on SS insulin pharmacy adds the hypo protocol, this states what to do if the BS is that low. But to answer your question, yes I would hold and call the PCP if no other protocols to follow were added to the MAR. A BS of 59 is very low and the pt needs further interventions now. Did you treat the low BS??

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