- 0Jul 26, '10 by GRUNGEif a patient has a high blood glucose and a long acting insulin is scheduled at that time, do i still use the sliding scale and give a short acting at the same time
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- 1Jul 26, '10 by CABGx4Absolutely! Give the long-acting insulin as scheduled and cover with the SS. Since long-acting insulins have no peak, the sliding scale will bring the glucose down quickly while the long-acting provides consistent insulin coverage over an 18-24 hour period. That is why SS's are usually ordered ACHS, q4, or q6, etc. to coincide with mealtime.
If the patient is NPO, you would still give the long-acting and any SCHEDULED short or intermediate acting insulins (for example, 25 units 70/30 in a.m.) but hold sliding scale coverage until feedings are restarted. D5 should be started if the pt is NPO. This policy may differ from place to place, but that was ours. I use to be nervous about giving lantus, 70/30, novolog, etc. while pt was npo, but I never had a patient experience a hypoglycemic event. You could hold the insulins if you're scared, of course, but expect hyperglycemia and the MD's probably won't be happy (like you care).
- 0Jul 26, '10 by blondy2061hI think of the long acting insulin as preventing hyperglycemia, while the short acting insulin is treating the hyperglycemia that's there now. If a patient was short of breath and had PRN albuterol and a scheduled steroid inhaler, you would still need the PRN albuterol. Probably not a 100% accurate comparison, but does illustrate the concept.
- 0Oct 5, '11 by jboyzRegarding CABGX4 I don't understand why you would hold the sliding scale in a patient who is NPO. Isn't the sliding scale correcting the high blood sugar, which the patient already has, regardless if they are eating or not. I would hold the scheduled insulin. I'm a new nurse still trying to research and figure out when to hold the different types of insulin and when not to hold. Any clarification on this topic would be helpful. Thanks
- 0Oct 5, '11 by xtxrnPersonal experience (I gave a lot of insulin when I was working...but it's a whole different ball game to figure out doses on yourself- LOL ).
Long acting (Lantus in my case) is just what I need to keep my blood sugar more level when nothing else is factored in. Sliding scale (or when people do their own- insulin to carb ratios ) cover anything added....meals, IV dextrose if NPO, etc.
If my blood sugar is say, 70mg/dl at hs, I still take all of the Lantus (I've gotten some grief over this in the hospital- and I understand it's coming from a POV of being safe.....but no two diabetics are alike) - and eat a snack.
If my blood sugar is 200mg/dl at hs, I take the Lantus, and take sliding scale - even if I'm going to bed. If I have a snack, the carbs are less.
Most diabetics who use carb counting and the insulin:carb ratio to determine insulin dose are REALLY good at it (or they just go with the "generic" sliding scale which isn't that great-doesn't take into consideration the # carb grams consumed- just the blood sugar
....and that makes a big difference). The I:C ratio is used to cover meals BEFORE they are eaten (though in the hospital, I would wait until JUST after, since I never knew how much I'd be able to choke down). Fast acting (NovoLog, HumaLog......NOT regular, though some people do use that for budget reasons) is designed to kick in faster than regular so the spike isn't as high after eating. It takes a while to figure out the ratio- and it can change w/illness.
Once you get something figured out with the orders for one patient, someone else will show up with a totally different set of numbers. And, I've given 100u Regular IV....for a blood sugar in the 400s, asymptomatic- but had high ketones..... I dragged the doc down to the room with me on that one
- 0Oct 5, '11 by agldragonRNQuote from jboyzcabg said that was the policy at her/his facility. holding the insulin is not an independent nursing judgement or action unless you have parameters that say "hold if npo" or "hold if bs < 100" or if your facility has a protocol that tells you when to hold. if you think you should hold the insulin for a reason, call the md and get an order.regarding cabgx4 i don't understand why you would hold the sliding scale in a patient who is npo. isn't the sliding scale correcting the high blood sugar, which the patient already has, regardless if they are eating or not. i would hold the scheduled insulin. i'm a new nurse still trying to research and figure out when to hold the different types of insulin and when not to hold. any clarification on this topic would be helpful. thanksLast edit by agldragonRN on Oct 5, '11