Would you have given the meds??

I would have talked to the MD about the previous FS of 39 in case s/he wanted to adjust the meds or investigate why the pt got so low. If I didn't speak to the doctor, I think the meds she was ordered for were safe (though not ideal) to give, and I wouldn't have held them. I'd watch her blood sugar closely, and make sure she knew what signs to report. I'd also record what she was eating.

Unless the doctor wrote orders or the facility's P&Ps defines specific parameters for withholding/changing insulin doses (e.g., "hold insulin if BG is under 70", "give half-dose if patient is NPO" and so on), the insulin should have been given as ordered. The BG was 127 and the patient was eating, so there wasn't really a reason why she shouldn't have had it.

i personally would have called the doctor for the blood glucose of 39 and followed up from there, because really the lab is critical... i would have called when i came on shift.. to clarify if he wanted to hold/adjust med times and the 70/30, just to be on the safe side.

we have a hypoglycemia policy which we can active for blood glucose of less than 60 and it has protocol of what to do if the pt is alert/not alert, has IV/no IV, etc... but we still have to call the MD to report the levels.

sorry the MD was such a jerk to you. he didn't have to act that way!!!

I would have given it. Had it been regular insulin I would have called for clarification. Had the off-going nurse's note not stated that the physician had been notified I would have notified.

Of course, in the best of all possible worlds with no fires to put out.

He's a jerk.

Must agree that the Doc. was pretty harsh. I think the previous nurse should have notified the Doctor about the low BG right away. My spouse is diabetic and we keep careful track of BG's, treat any hypo episodes and notify the Doc. right away about any hypoglycemic events and change the doses of the meds.

Anyways, you did well and the patient was cared for.

I reiterate what I stated earlier - it was definitely the responsibility of the previous nurse to call the MD. That should have been clarified in report.

This IS frustrating. The off going RN should have reported this. One thing that may help you in the future--when you are getting report, highlight any issue that may be (or lead to something) critical. Ask the off going RN how it was addressed and what the plan is. If it wasn't addressed, it is what it is. No blame needs to be laid on anyone, the previous nurse may have been caught up with something else, it doesn't matter why. You have the information you need, and you know that you need to contact the MD.

I'd also let the other nurse know what happened. In report you are both responsible for clarifying important information--hopefully she will learn from this scenario also.

And you know, some docs would have yelled at you for NOT giving the insulin in this case. It depends on the patient, the circumstances, and the clinician. But the yelling thing--the fact that the doctor was a huge arse about it is not your problem, it's his.

These kinds of things happen all the time. This is where developing a little thick skin is most important. Consider this--what if the pt DID have critical hypoglycemia after you gave her meds, or, say she went into DKA because you held the insulin? Regardless of what you had done, you would find a way to blame yourself for the outcome of the pt, and someone else would try to pin it on you (because they're so scared that they are to blame). It's impossible to not let this get to you. My advice is--surrender to your powers of assessment and critical thinking, and separate them from your emotional self. Always know the rationale for what you're doing. If questioned about it later, you state your assessment and your rationale and stick to it. It's ok to acknowledge when things could have been done differently, but usually your assessment/rationale/actions will not be far off from what any other reasonable clinician in your position would have done.

The blood sugar was a critical result and the previous nurse should have notified the MD. If she couldn't reach the MD, she should have told you to follow up on it. If you thought the MD had been notified and the patient's blood sugar was ok when you gave the meds, you did nothing wrong.
I recently had a patient with very low blood sugar before breakfast. Blood sugar was up to normal after juice and snack. Patient had lantus ordered as well as humalog to be given with meal. I called the MD to clarify whether I should still give these meds and if he wanted the dose adjusted. The MD was irritated with me and said of course I should give all meds because if the patient eats and has no insulin, the blood sugar will be critically high. So, sometimes you can't win either way, but if you check with the MD then at least you have covered yourself.

Those endocrinologists! If you give the meds and the patient becomes hypoglycemic, they yell. If you don't give the meds and the patient becomes hyperglycemic, they yell. I usually follow the RN that did not notify the physician (or never rechecked the sugar of 30). I would hold all meds until the endocrinologist rounded and ask if he or she wants to consider a dose or medication adjustment. If you are every unsure - call! Getting yelled at over the phone is nothing compared to in person.