[Marti Ann]

Hi,
I have a question, and I need a few nurses opinions. I had a case this week. It was a Pt. in a nursing home who is a Brittle Diabetic. The ARNP sent her to the hospital without any insulin coverage.her BS was 498 and she was in a coma.VS unstable, and temp 100.1
what do you think?

Some nurses think since she should have gotten some insulin and other think it would have mask the S/S of her congestion and temp. She arrived at the hosptial within 1hr and 15 mins. she had 8 units at 8am. and was going down hill after 10:30 in the morning.
Abuse feels there was some neglect too.
Was the ARNP at fault?
He changed his story a few times talking to me.
he said at one time ,since her checks were BID and thought she got insulin at 12 noon. then restated" oh I thought it was just better to sent her to the ER". She didn't even go 9ll.
you may email me or let me know here.
thank you all for your advise.
Marti Ann
Ombudsman Nurse Consultant

[LilgirlRN]

She should have been given insulin. While her illness probably caused her increased blood sugar I fail to see how treating the blood sugar is goign to affect the illness or mask it's symptoms. There really isn't enough information here, if she's in a nursing home, she is probably elderly, most old people don't go DKA which would be an assumption one would make about a brittle diabetic. More than likely the illness killed her, I would guess pneumonia. Without more information I can only assume what happened. Still my opinion that withholding her insulin did nothing to help her or to help anyone decide what her problem was.

[VivaLasViejas]

I would do a little more digging here........for instance, how long has the ARNP been caring for this patient? How often has he seen her, and how familiar is he with her history? I'm surprised he didn't order insulin coverage for her on admission to the hospital, but then again, I've rarely seen a brittle diabetic in a coma caused by a BS of 498........most of the ones I've cared for are alert and oriented at that level, and the ones who aren't, are merely somewhat confused. Of course, I don't know what the temp and unstable VS stems from (I'm assuming an infection of some sort), but we all know how infection affects blood glucose levels, so it seems to me that treating the elevated BS with insulin and the infection with antibiotics would be a logical course of action.

Again, I wish I had a little more background info on the NP and the patient.......in particular, how aggressively she wants to be treated per her advance directive (if she has one), her relationship with this NP, her code status (regrettably, DNR is sometimes misinterpreted as "do not treat"). Neglect is a VERY serious charge to make against a nurse or physician, so a thorough investigation is necessary. Good luck to you.