Pt. with Type 2 diabetes bottom out?

[samiam4]

I ordered lunch for my patient. I administered Novolin (11 units). Blood sugar was 295. Once food came Pt said he wasn't hungry. He just wanted to eat his peaches. So, he ate his peaches. Could the pt. bottom out from only eating peaches? (5 peach slices).

[nurse2033, MSN, RN]

Perhaps, (if unlikely) but you should educate the patient on the need to eat to prevent that from happening, even if not really hungry. Not that they should stuff themselves but peaches wont last long metabolically speaking. Something with a little more staying power, like some crackers with peanut butter would be better.

[AgentBeast, BSN, RN]

It's possible, but highly unlikely.

[MN-Nurse, ASN, RN]

It depends on a LOT of other factors besides what happened at one meal.

When patients' glucs and eating habits are labile I just check them more often.

[GitanoRN, BSN, MSN, RN]

Unquestionably, it is unlikely to this occur, however, providing pt. education, and asking the pt. what snacks they like, as long as they are within their diet regiment; I would ask their relatives to get these for him. In addition, I would monitor this pt. closely, but most of all; document throughly the situation and your solutions to the matter. Good luck, and best wishes to you always.

[samiam4]

Thank you for the replies!

[LobotRN, BSN, RN]

Before answering that, I would be curious to know if the 11 units was a sliding scale correction for the blood sugar only, if it was sliding scale for the carbohydrates in the meal only , or if it was a combination of both.

If it was only for the blood sugar of 295 and the pt insulin sensitivity ratio is indeed 18mg/dL glucose to 1 unit of insulin, then unlikely that they would bottom out, but could happen (assuming the correction target for blood glucose is around 100mg/dL). Plus the pt ate a few peaches.....

If, however, the insulin was combination of correction for glucose and carbohydrate content of the meal, then yes, much more likely to bottom out if pt did not eat the carbs that the insulin was "expecting to cover."

Lastly, if it was only a dose for the carbohydrate content of the meal, then the high blood sugar would have acted as a "buffer" in the sense that the patient already had his "carbs" on board.

[BlueDevil,DNP, DNP, RN]

I'd say it depends how dramatic the patient is and how many family members are hovering, lol.

Generally speaking, no, not likely to have a true hypoglycemic event.

[samiam4]

It was a sliding scale of 9 units Novolin R and +2 units Novolin R (seperate from the sliding scale). I'm a student so i'm not really familiar with how insulin works. I'm trying to make sense of it all.....

[Wave Watcher]

I am a School Nurse and I do insulin to carb ratio. I do NOT give the insulin until AFTER they have eaten and I actually see their food tray.