Does nights or first shift give your insulin? - page 2

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... Read More

  1. by   Ariesbsn
    Once we switched to the bar-code/scan system, our morning insulin orders show up being due at 0730. Since it doesn't show up as a "to do" for my shift it is technically the responsibility of day shift. I try give all of the meds scheduled for the 0700-0800 time period so to give the day nurse a bit of a break. Since I generally only have 2 pts, most days it is possible.
  2. by   wooh
    Quote from Chaya
    I really don't feel comfortable giving the insulin coverage if I haven't done the fingerstick.
    I feel even less comfortable giving insulin without seeing the meal tray, which is what nightshifters have to do if they give breakfast insulin.
  3. by   allele
    Depends. If the patient is on regular insulin (quite rare these days where I work!) then the sticks are done at 0700 and the night shift covers, since regular takes a little time to kick in. If the patient is on Novolog (almost all of them), then we need to check the glucose as close to meal time as possible....so it's done at 0730, when we get trays, and they're covered by the day shift.
  4. by   Ariesbsn
    Trays are one thing that I rarely have to worry about. Most of my patients who need accuchecks are on either tube feeds or TPN.
  5. by   Myxel67
    [font="comic sans ms"]
    Quote from giggles
    i work straight night at a nursing home and i have to do the bs checks between 0530 and 0600. day shift starts at 0700 but does not give insulin until 0800-0830 with breakfast. if the residents bs is below 5 i give juice or glucogon if needed.
    [font="comic sans ms"]insulin should not be given at 0700 or 0800 based on a bg that was checked 2 1/2 to 3 hours earlier. if analog insulin is being given, bg should be checked about 30 min before meal, and insulin can be given anytime after bg checked and by the end of the meal. both sliding scale and premeal insulin should be given together. if bg is high--say, 200 or above, insulin may be given earlier to give it more time to start to work. if the doctor still insists on ording regular insulin, it should be given 30 to 45 minutes before the meal. regular insulin does not give thenurse the flexibility of giving the insulin during the meal or at the end of the meal--by the time the insulin is working, the food is gone. if premeal insulin is analog, ss should be analog as well.



  6. by   Myxel67
    Quote from allele
    depends. if the patient is on regular insulin (quite rare these days where i work!) then the sticks are done at 0700 and the night shift covers, since regular takes a little time to kick in. if the patient is on novolog (almost all of them), then we need to check the glucose as close to meal time as possible....so it's done at 0730, when we get trays, and they're covered by the day shift.

    [font="comic sans ms"]of all the practices described in this thread, this one is the best. at my hospital, trays don't come until 0800 or 0830. but as you said, if analog insulin is ordered, check bg (up to 30 minutes ac is fine)& give insulin after bg check--can still be effective even if given midmeal or at end of meal. as mentioned above, if bg is high, analog insulin can be given sooner to give it a chance to start to work. ss and premeal insulin should be same type. we try to encourage docs to avoid regular insulin, but old habits are hard to change.

    even though analog insulin peaks in about an hour, the peak physiologic effect isn't felt until 2 to 3 hours after injection (this is time bg most likely to drop if dose too high or food intake too little.) if there are pts who have poor appetites, since analog insulin can be given at end of meal, pt carb intake can be noted and insulin adjusted if necessary.
  7. by   SICU Queen
    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.

    If you're giving a longer acting, routine insulin like an NPH or 70/30, then that should be given on dayshift.
  8. by   allele
    Quote from myxel67


    [font="comic sans ms"]of all the practices described in this thread, this one is the best. at my hospital, trays don't come until 0800 or 0830. but as you said, if analog insulin is ordered, check bg (up to 30 minutes ac is fine)& give insulin after bg check--can still be effective even if given midmeal or at end of meal. as mentioned above, if bg is high, analog insulin can be given sooner to give it a chance to start to work. ss and premeal insulin should be same type. we try to encourage docs to avoid regular insulin, but old habits are hard to change.

    even though analog insulin peaks in about an hour, the peak physiologic effect isn't felt until 2 to 3 hours after injection (this is time bg most likely to drop if dose too high or food intake too little.) if there are pts who have poor appetites, since analog insulin can be given at end of meal, pt carb intake can be noted and insulin adjusted if necessary.

    thanks!! we have a high diabetic population, so we deal with this a lot and the docs were easy to convert....our diabetic education team has a lot of pull, as they should since they really are experts, and they work very closely with an endocrinologist, so they've made many, many changes in policy over the years! it sounds like you work with a lot of diabetics too, and what we've been seeing a lot more of the last couple of years is carb counting. i'll admit it's a pain, but it really keeps them under control. do you see this a lot too??
  9. by   NJNursing
    In my 268 bed hospital, the night shift does blood sugars roughly between 6:15 and finishing around 6:45 and then covering at 7am while the day shift is putting their things away, getting pt labels, getting things together. Breakfast is ordered like room service here and pt's can order as early as 6:30 and most are eating between 7 and 8am.
  10. by   Giggles
    Quote from myxel67
    [font="comic sans ms"]

    [font="comic sans ms"]insulin should not be given at 0700 or 0800 based on a bg that was checked 2 1/2 to 3 hours earlier. if analog insulin is being given, bg should be checked about 30 min before meal, and insulin can be given anytime after bg checked and by the end of the meal. both sliding scale and premeal insulin should be given together. if bg is high--say, 200 or above, insulin may be given earlier to give it more time to start to work. if the doctor still insists on ording regular insulin, it should be given 30 to 45 minutes before the meal. regular insulin does not give thenurse the flexibility of giving the insulin during the meal or at the end of the meal--by the time the insulin is working, the food is gone. if premeal insulin is analog, ss should be analog as well.



    i totally agree that bg and insulin should be checked a lot closer together. when i started at this facility that was the norm because day shift does not have time to check bg during meal time and do there med pass as well. which i think is a bunch of crock. where i used to work bg was checked then insulin was given depending on bg right away. not only do we check the bg on night shift, the doc ordered that bg be done once a week for people that were on insulin. i guess he felt that the bg was stable and only needed to be checked once or twice a week. again i think this is a bunch of crock. all of our insulin dependent residents have extremly high bg, the docs answer to this, do teaching re: eating proper foods and portions. none of these resident listen to teaching and just get mad when they do not get a second helping or dessert. it is a joke.
  11. by   TrudyRN
    Quote from muffie
    we do our own chems
    we give our am insulin at 0830 when breakie arrives
    \I think the Wake Up, Neo thing is a reference to the movie "The Matrix". The character, Neo, was played by the great-looking Keanu Reeves. It is sort of a hard movie to grasp but he was totally cool to look at.
  12. by   Myxel67
    [QUOTE=SICU Queen;2187497]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).



    [QUOTE=SICU Queen: If you're giving a longer acting, routine insulin like an NPH or 70/30, then that should be given on dayshift.[/QUOTE]

    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.
  13. by   grace90
    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.

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