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| No. 30 | 
Oct 08, 2009, 03:23 PM
 Re: Would you have given the meds?? Originally Posted by cherick22  I have yet to see a diabetic labeled as Type I or Type II. I was wondering that recently about one of my patients and was unable to find the answer, even the patient didnt know and couldn't tell me when they were diagnosed. Histories only report NIDDM or IDDM which still doesnt identify the types. Still think the OP did the right thing.
I usually find that my adult Type I patients know their way around the disease more than the Type II ones. They have been dealing with it for a long time, they know their A1c, and they are more concerned (in general) about keeping their blood sugar under control (especially in the hospital setting). I have found some of them to have more labile sugars--more likely to get below 60 or go over 300. I don't think I've ever had a Type I diabetic NOT know the distinction between Type I and Type II. Many people with Type II, however, don't know which type they have, are less comfortable around insulin, and typically have less understanding of the disease. This is totally my own anecdotal experience.
Type I diabetics will never get oral hypoglycemic treatment because all PO meds require that the patient have some capacity to make their own endogenous insulin, and Type I diabetes is defined as absolute insulin deficiency. I stay away from NIDDM/IDDM because I don't feel that this distinction adequately describes the difference between Type I and II. Many people with Type II diabetes will ultimately require exogenous insulin treatment, but this is a later stage of the disease and the patient typically has a very different course than a patient with Type I diabetes.
 | | Advertisement Sponsored Links | | | | No. 31 |
Oct 08, 2009, 06:48 PM
Re: Would you have given the meds?? Originally Posted by silas2642 I think that you should have paged an MD if her glucose was down to 39 and asked what he wanted to do with the meds-- hypoglycemia can be dangerous; remember that glucose is the brain's only source of energy. However, he should have also written an order "page MD if blood glucose is less than x or hold meds if glucose less than;" you're a nurse, not a doctor. Personally, I think that he just freaked because something bad could have definitely happened if her glucose dropped too low and he would have been responsible for the incident.
The night nurse did page the MD, this nurse gave the meds at 0800. If the MD wanted to hold the meds and insulin, he should have given that order when the nurse called him at 0600. I dont see anything wrong with what she did, in fact I would have given the 70/30 as well. The pt was eating and had a BS of 127, what's the problem? That MD has issues, she did nothing wrong.
| | No. 32 |
Oct 08, 2009, 06:55 PM
Re: Would you have given the meds?? Originally Posted by meluhn The night nurse did page the MD, this nurse gave the meds at 0800. If the MD wanted to hold the meds and insulin, he should have given that order when the nurse called him at 0600. I dont see anything wrong with what she did, in fact I would have given the 70/30 as well. The pt was eating and had a BS of 127, what's the problem? That MD has issues, she did nothing wrong.
Correction: After reading more of the thread, I realize that the night nurse did not page the MD, so I would have let him know about the bs of 39, but still, I would not have expected him to hold the insulin or meds with a bs of 127 and pt is eating.
| | No. 33 |
Oct 09, 2009, 06:59 PM
Re: Would you have given the meds??
For a FSBS of 39, I would have pushed D50. Then given her meds. You never, ever, hold meds without calling the DR and getting an order to do so.
| | No. 34 |
Oct 09, 2009, 08:41 PM
Re: Would you have given the meds??
[quote=Mudwoman;3907798] You never, ever, hold meds without calling the DR and getting an order to do so./quote]
I disagree, you can use your judgement and hold meds if you deem it neccessary, then just let the MD know. We are not order following drones and as long as you have sound reasoning to back it up, you will be fine.
| | No. 35 |
Oct 09, 2009, 09:20 PM
Re: Would you have given the meds??
[quote=meluhn;3907991]
Originally Posted by Mudwoman You never, ever, hold meds without calling the DR and getting an order to do so./quote]
I disagree, you can use your judgement and hold meds if you deem it neccessary, then just let the MD know. We are not order following drones and as long as you have sound reasoning to back it up, you will be fine.
At the hospital I work at with the DR's I work with, that philosophy is a good way to loose your license. Waiting 10-15 min for a call back from the physician is not being a drone.
| | No. 37 |
Oct 10, 2009, 12:31 AM
Updated
Oct 10, 2009 at 12:38 AM by I_LOVE_TRAUMA
Re: Would you have given the meds??
you have to give the scheduled DM meds as ordered, as long as the patient has eaten & has a normal bs, especially if they have some other kind of acute illness going on (bs will be harder to control), why does your hospital not have protocols in place for this type of thing? We have a long list of standing orders at our disposal for just this type of situation, if bs is okay always give scheduled po and sq meds. if low should give s/s as indicated, if very low give D50, if semi low recheck after eating then do this, when to start a gtt... and so on. You should not hold 70/30 for a bs of 127, but sounds like a lot of miscommunication went on, good luck to you, & if you don't yet have protocols in place such as this, then please push for them, it is so important to maintain very tight bs control, especially when their is other things going on, it only takes a few severe hyperglycemia episodes to cause severe permanent damage.also, it really doesn't matter if type 1 or 2 at this point, most diabetics require, or are treated with insulin in the hospital, and obviously her bs have been high in the past if get 70/30, we need to control the high bs the quickest way possible and then try to wean her to po if possible
| | No. 38 |
Oct 10, 2009, 03:09 AM
Re: Would you have given the meds??
I think your doctor was way all out of line. If pt's bg was 127, i see no reason to hold oral hypoglycemics. I would have probably held the insulin, but not the oral meds.
| | No. 39 |
Oct 10, 2009, 08:40 AM
Re: Would you have given the meds??
We have a hypoglycemia protocol. BS of < 65 give D50 call MD. Then they can do what hey want with the meds. But I think this MD overreacted a pt eating w/BS of 127 would have got meds IMO.
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