When to give insulin? - page 3
by kriegerkriegr | 10,577 Views | 24 Comments
When it comes to diabetics and giving insulin, I have seen a few methods out there: -give the insulin only at meal times or at least have snack and juice in front of the patient. -give the insulin at the time after the... Read More
- 0Jun 21, '12 by bclem05Hi guys, I'm really interested in how you deal with morning glucose checks. I work on a busy tele floor, currently night shift is doing the morning glucose checks and coverage around 6 AM, trays aren't passed till around 730. As you can see this is problematic. A little background information, my hospital is still stuck in the past in regards to DM management in that only about half of the patients have basal coverage although we are starting to see more and more and the majority of blood glucose control comes from a sliding scale, typically with the use of Aprida. Also we do 12s 7 to 7. So my question is who (day or night shift) checks the blood glucose and at what time? who is administering the insulin and at what time? and how fast are trays received after insulin is administered?
Thanks in advance
- 0Jun 22, '12 by smleahy11@bclem I work on a tele floor too. We do our accuchecks at the same time you do. I find that most nurses don't mind if you don't give the insulin as long as you tell them that you didn't give it. I personally do not like to give Novolog until the person is eating. I always tell the oncoming nurse, there accucheck was this, I didn't give the sliding scale. I did not want the blood sugar to drop and create a bigger problem for you. Hope this helps.
- 0Jun 22, '12 by suannaThe problem isn't purely nursing judgement, but the doctors orders. In the case you gave- I wouldn't have had a problem giving the patient the ordered insulin- you had a LOT of room before you were in danger of a significant hypoglycemic episode. If the sugar was 86 with orders to hold or reduce the dose if bg<80 I would consider waiting for the tray to get there and making sure the patient was going to eat before I gave a dose. Same thing if I felt there was a chance they were not going to be able to eat thier normal diet. Tighter glucose control is a big core measure in hospitals right now. As everyone else has said- long acting-basilar insulins are always given, but meal coverage is best when your ordering doctors give you some latitude in nursing judgement- (If eating only liquids give only 1/2 dose, if eating <25% hold all meal coverage...)With a little flex in the order it is easier to justify waiting till the patient is eating to give the insulin. Yes- I know it is a little late- but I would rather have the insulin kick in 30 min late and have the bg spike up to 200 before dropping than have it kick in on time and have a patient "not feel like eating" and have a glucose of 60 for the next 4 hours. It's tough to suck it back out if they refuse thier tray.