[scrmblr]

Took report on a very very sick pt last night.

Bg upon arrival was 1300. pt was unresponsive, kussmaul breathing, fever, ketones in urine. Maintaining sat's on 4lt of 0's via n/c. Tachy at about 112-130.

Nurse giving report had the pt on an insulin gtt at 8u per hour. She had not repeated a finger stick bg in 3 hours. When I did a finger stick the bg came up as 146...Lab repeated and it came back as 555.

What is your policy on insulin drips and bg checks? If you don't have a policy what is your practice?

[Larry77]

With an insulin drip we usually check BG every 30 minutes unless they are symptomatic then possibly even more often than that.

I would not have run an insulin drip for 3 hrs without rechecking a BG...yikers.

[NeuroICURN]

Well...our facility uses different drip constants for insulin gtts. Our insulin drips are mixed as a 1unit/1ml.

So, the constants are usually anywhere from 0.02 to 0.08. The rate of the insulin gtt is determined by the most recent BGM....and the gtt rate (units/hr) changes with each BGM.

The way our protocol works is that the goal BGM is 100-150. When the insulin gtt is started, the BGM is checked hourly x3. Then it is continued to be checked hourly until you get three consecutive BGMs that is 100-150, then it can be checked every 2 hours, until it's out of that range again, at which time it goes back to hourly checks.

Now, if the BGM is below 100, the gtt is stopped for one hour and rechecked again after that hour is up....if it's above 100, then the gtt restarts with the hourly checks x3.

However, if a constant of 0.04 or higher is being used and the BGM is below 130, then we consider using a lower constant.

If the pt continues to have high BGMs, then we consider using a higher constant.

If the insulin gtt has to be stopped more than 2x in the last 24 hours, then we consider stopping the gtt and going back to a Q6h or ACHS schedule with sliding scale coverage.

It sounds more complicated when it's typed out than what it actually is. Hope this helps.

[RazorbackRN]

Originally Posted by scrmblr

Took report on a very very sick pt last night.

Bg upon arrival was 1300. pt was unresponsive, kussmaul breathing, fever, ketones in urine. Maintaining sat's on 4lt of 0's via n/c. Tachy at about 112-130.

Nurse giving report had the pt on an insulin gtt at 8u per hour. She had not repeated a finger stick bg in 3 hours. When I did a finger stick the bg came up as 146...Lab repeated and it came back as 555.

What is your policy on insulin drips and bg checks? If you don't have a policy what is your practice?

BS 110-150 q2. No change in rate.
BS < 110, Insulin off and recheck hourly. Insulin back on at 1/2 of previous rate when BS >120. Recheck Q2.
BS > 150 Q1. Increasing by 1 unit hourly until < 150.

[Larry77]

Yes...good answers from the past two posts. In my case we are usually just using the drip short-term to get a very high BG down and when their sugar is WNL we d/c the drip, But if the patient is headed to the ICU we use a protocol similar to the ones mentioned above.

[augigi]

What is your hospital's policy, OP?

In my ICU, we had a strict IV insulin algorithm to keep BSL 5 - 8 mmol/L. Much evidence in the literature that post-cardiac surgery the patients get better outcomes and less infections with very tightly controlled lower BSLs. Depending on the blood sugar, we rechecked in an hour and adjusted infusion if required.

[Knoodsen]

In my experience, the norm seems to be FSBS q1h when the patient is on an insulin drip. Of course, in the ED, this gets done when and if the nurse has time (we get kinda busy from time to time, you know).

[RN-Cardiac]

At our hospital all insulin drips are on a computer program (glucomander),..a small lap top,.enter the glucose level,.it tells you what rate to set the drip and when to do the next accu check,..it beeps when the next accu check is due,...glucomander is somewhat of a "dirty word" on our unit as it is soooo time consuming,...often accu checks every 15-30 minutes,..but after reading these posts I can see how I wouldn't want to have an insulin drip w/out it!

[augigi]

Sounds excellent - never heard of that, will have to look it up.

[Christie RN2006]

I had to start an insulin drip on my patient today... my hospital is now using algorithms for patients on insulin drips. You have to do blood sugars every hour until the patient is WNL for at least 4 hours. If their blood sugar doesn't drop by so many points, you have to move to the next algorithm and recheck it in an hour. They also have to get their electrolytes checked 4 hours after starting the drip. Luckily they have the all the orders for it on a printed sheet, so it is pretty simple to follow.