Pretty much every patient that I have taken care of has been on sliding scale insulin or an insulin gtt. So I completely understand checking the BS before injections or according to protocol, then administering appropriate units/adjust the gtt rate accordingly, and holding the insulin if BS is WNL or too low...etc.
I was charge the other day during our last clinical. One of my students had a pt that was getting scheduled insulin that morning, and he had SSI AC/HS. I can't remember which type of insulin was his scheduled insulin was...sorry but I am sure it was not regular, and it wasn't Lantus, maybe an intermediate acting insulin. I should have paid more attention. Anyway, his scheduled insulin was not on the floor yet. The student checked the BS and it was 85. Held the Reg SSI and the pt ate breakfast. At 9 or so the scheduled insulin came up and she administered that. Before lunch she rechecked his sugar and it was 45 but was not showing any clinical signs of hypoglycemia. We alerted the real nurse, got some crackers and juice, and then I went and got my instructor. He seemed to be fine, instructor said no need for D50, rechecked the BS p 30min and it was 150.
I didn't think to ask these questions then, but after I got home I started wondering. If a pt is getting scheduled insulin, you still check the BS right and hold only if the pt's BS is lower than 70? or would you hold if the BS was WNL as well? Did the pt's blood sugar drop because he had already eaten...i didn't think that intermediate insulin would peak that quickly? And my last thought, is perhaps she didn't wipe away enough of the alcohol...I didn't watch her take the BS. Could that have produced a false low, since the patient was not showing any s/sx if hypoglycemia. Would you have rechecked it to make sure it was accurate?
Sorry if these are dumb questions.