Does nights or first shift give your insulin?

[TooterIA]

In my 25 bed hospital, nights does fingerstick blood sugars between 6-7am, and our shift ends at 7:30. Days comes out of report at 7:30 and gives sliding scale insulin based on the blood sugars nightshift did. Which shift does these responsibilities in your facility?

Jessica

[Myxel67]

If you're giving regular insulin to cover a blood sugar, then meal time shouldn't matter. Whoever checks the glucose should give the insulin right away to cover the elevated glucose.

In fact this is true even if the insulin is an analog insulin--as you said, the ss covers the elevated glucose and is not given in anticipation of a meal. BUT if the patient has scheduled mealtime insulin in addition to ss, following this method will require giving 2 injections. HOWEVER, ss is usually ordered ac & hs for pts who are eating. While 6 am is technically "before breakfast," so is 2 am--so why don't we do them then and cover ss just to get them out of the way? The time for ac fingerstick and injection depends on the insulin--regular--check BG 45 to 60 min ac and give insulin 30 to 45 min ac (mix with NPH if NPH ordered). Analog insulin--check BG up to 30 min ac. Insulin should be given before meal starts, but can still be effective if given right at end of meal. (Again, mix with NPH if NPH ordered).

Novolin or Humulin 70/30 are premixed NPH and regular insulins. Because the regular insulin is meant to cover the meal, this insulin should be given 30 to 45 minutes ac. Novolog Mix 70/30, or Humalog Mix 75/25 should be injected 5 to 15 minutes ac since the analog portion is meant to cover the upcoming meal.

[grace90, LPN, LVN]

At my facility, nightshift does the fingersticks between 6 and 7 am, and dayshift gives the 7:30 insulins since pts rarely have their breakfast before we start report at 7. If the blood sugar and coverage was ordered for 5 am, then nights does the insulin too. There is one floor that is the exception, though, and the only floor in which the day shift nurses expect the night shift nurses to give all the insulin coverage *including* Humalog. I've tried debating that with the nurses on that floor but it's a waste of oxygen. :deadhorse When I float there on night shift I don't give it. I don't like giving a Humalog coverage at 6:45 when I know it could be over an hour before the pt eats.

[Pepper The Cat, BSN, RN]

Day shift does their own Glums and gives their own insulin. Most of us didn't feel comfortable giving insulin according to a Glum that could be 2 hours old. Also, most of us don't like giving insulin until the breakfast tray has arrived! I had an incident where I gave the insulin, and then there was a problem with the pt's breakfast tray - it finally came 45 minutes late (and 3 calls to kitchen saying I need that tray). Now, I wait until the tray has arrived!

[Myxel67]

Day shift does their own Glums and gives their own insulin. Most of us didn't feel comfortable giving insulin according to a Glum that could be 2 hours old. Also, most of us don't like giving insulin until the breakfast tray has arrived! I had an incident where I gave the insulin, and then there was a problem with the pt's breakfast tray - it finally came 45 minutes late (and 3 calls to kitchen saying I need that tray). Now, I wait until the tray has arrived!

What was pt's BG before insulin given? How much insulin and what type? How low did pt's BG drop?

[JaneyW]

I work with pregnant ladies trying to get their insulin under control--usually the reason they are there. This thread has been both confusing and enlightening to me. I know I need to spend some time with the diabetic educator! We have room service method here, so we never give insulin until the tray arrives because there is no real schedule. Most of the insulin we give is regular or humalog and we give it on days with breakfast. We don't usually have SS--it is a fixed order. They do the FBS around 6-6:30. I know pregnancy throws a wrench in 'the usual', but I think maybe I need to get more education about all of this!

[Pepper The Cat, BSN, RN]

What was pt's BG before insulin given? How much insulin and what type? How low did pt's BG drop?

I really can't remember how low the blood sugar went. The pt knew she was dropping so I was giving her juice, cookies anything I could find (which isn't much). Luckily, it didn't get to the point where I had to resort to glucogon or glucose IV.

Long story short - pt was fine nurse was stressed and now I don't give insulin at meal time until the tray has arrived! Our dietary system is not dependable enough!

[Thornbird]

Night shifts used to always do the insulins back in the days when most patients were getting NPH some with a small amount of Reg. No blood sugar checks back then. I think old habits are hard to break in nursing and this "custom" has continued in many places. I greatly dislike when I am required to give insulin before 7AM when most times breakfast doesn't get to the patient until 7:30 to 8:30. Todays insulins, even the regular generally act faster than the old regular. But, I follow orders. I have never been anywhere that the nurse giving the insulin relied on a sugar done by someone else at another time. BS can be quite different an hour later.