accu checks in ltc

[cincin1222]

Hello all,

Just started a new job at a ltc , and I am torn apart on when to do accue checks, because I'm getting different type of information from some of the nurses that are there. I do accu check on all the patients that are on insulin regardeless if it's 70/30 or novolog before I administered it, but they are telling me I should only do it if it's an order. So my question is when it comes to ltc are you suppose to inject insulin without checking the bg before on all of the patients that are on insulin? because I'm being told not every resident are accu check.

[ricksy]

Obviously you would do accuchecks before novolog-R-NPH-Premix, but there always seems to be that question about before Lantus and Levemir. There have even been discussions on this site about whether or not you even HOLD the long acting. Our facility just implemented policy that accuchecks are mandatory before the long acting and got orders to do so.....

[BrandonLPN, LPN]

Obviously you would do accuchecks before novolog-R-NPH-Premix, but there always seems to be that question about before Lantus and Levemir. There have even been discussions on this site about whether or not you even HOLD the long acting. Our facility just implemented policy that accuchecks are mandatory before the long acting and got orders to do so.....

Why on earth would you check blood sugar before administering levemir/lantus? This just shows a fundemental lack of understanding of the nature of the medication on the part of your facility's policy makers.

It is perfectly normal for diabetic nursing home residents to have their bllod sugars checked only once or twice a week, provided they're stable.

Of course, it is always the nurse's privilege to check a blood sugar whenever he or she deems necessary. So saying you can "only" do it when there's an order is false. But this would be in cases where you had reason to believe the resident is having blood sugar level issues. If they're presenting with symptoms.

But for the OP to check before each administration of 70/30 is overkill unless, again, the resident is presenting with symptoms. Or if they're NPO or vomiting. The reason the resident is on a routine dose of 70/30 is because they've demonstrated stablity.

To check everytime regardless, "just to be safe", reflects poorly on nursing judgement, IMHO. And it infringes on the rights of the resident.

It's like checking BP before every does of lopressor or something. It's just not necessary. These people have been on these medications for a long time. An effective therapeutic dosing regimen has already been established.

[lauriepat, ASN, RN]

It depends on where you work/facility policy/md orders.

Where i work all of our diabetics get long and short acting together (i don't mean mixed!!) most w a sliding scale so we have to check it.

I do understand the point of not checking it just for long acting..esp if they have been stabilized on the dose.

It is a nursing judgement to ck BS if your pt presents w symptoms.

Check with your DON/facility policies to be safe.

[ricksy]

Why on earth would you check blood sugar before administering levemir/lantus? This just shows a fundemental lack of understanding of the nature of the medication on the part of your facility's policy makers.

It is perfectly normal for diabetic nursing home residents to have their bllod sugars checked only once or twice a week, provided they're stable.

Of course, it is always the nurse's privilege to check a blood sugar whenever he or she deems necessary. So saying you can "only" do it when there's an order is false. But this would be in cases where you had reason to believe the resident is having blood sugar level issues. If they're presenting with symptoms.

But for the OP to check before each administration of 70/30 is overkill unless, again, the resident is presenting with symptoms. Or if they're NPO or vomiting. The reason the resident is on a routine dose of 70/30 is because they've demonstrated stablity.

To check everytime regardless, "just to be safe", reflects poorly on nursing judgement, IMHO. And it infringes on the rights of the resident.

It's like checking BP before every does of lopressor or something. It's just not necessary. These people have been on these medications for a long time. An effective therapeutic dosing regimen has already been established.

The levemir/lantus question and debate has been on this site before. I am not saying it is my opinion, but my facility requires it, and as put fourth on this forum before, there are others that agree. Our facility also requires accucheck for other types, siteing Davis Drug book "monitor blood glucose every 6 hours"..(insulin mixtures). I didn't make the rules, I am simply stating was facility rules are. Thanks for your time and consideration.

[Salisburysteak, BSN, RN]

Where I work, we have orders for our Diabetics. Some Residents we check ac & hs, others BID usually at 6:30am & 4:30pm, and some just weekly.

As for Levemir/Lantus, I was taught to never hold long acting insulins.

Also our Diabetics get their A1C checked q 3 months.

Of course you do want to check when a resident is showing symptoms of hypo/hyperglycemia. We also do have SSI for the residents. Check the MAR or POF of the resident. The POF should have all of their lab & orders on it.

And all of your Diabetics should be getting snacks on a regular basis especially HS snacks.

[Havin' A Party!, ASN, RN]

Learn your facilities policies on diabetics. Follow written orders.

Get to know your patients, and keep tabs of any symptoms or changes in status. Use your judgment and get a reading to make sure they're safe.

[dream'n, BSN, RN]

I would never give insulin without an accu-check. Even if a patient is considered 'stable' on long acting insulin such as Lantus, many variables could be affecting their blood sugar. Some such variables are poor intake, what foods/drinks have or haven't been consumed (Proteins vs. Carbs), physical activity, stress, and even minor illness.

For example, let's say a patient receives 25 units of Lantus q hs on a daily basis, therefore the nurse doesn't check the blood sugar prior to administration. Lantus begins action 1 to 1 1/2 hours after administration and Levemir 1 to 2 hours. Let's also say that the unchecked blood sugar at 2100 is 55 because the patient is starting a UTI and had a stressful day in PT, therefore their BS is lower than usual. If the patient is given their usual Lantus/Levemir dose they will easily bottom out overnight.

It is also important to remember that following Polices/Procedures won't protect you if they are not Standard Nursing Practice. As a licensed/registered nurse you are responsible for your practice. And just because a patient is in a LTC that is supposed to be "like home", nurses are responsible for their care and they are held to a higher standard. Otherwise why would a nurse be there at all?? The LTC would be staffed with homemakers.

[dream'n, BSN, RN]

Never hold long acting insulin? What if a BS is 60? With even long acting insulin working within 1 to 2 hours...I would not give and speak with the doctor for instructions.

[morte, LPN, LVN]

because the prior dose of Lantus will have worn off by the time the next dose starts to take effect. If the patient is symptomatic, take the ,blood sugar. You hold the long acting, you are likely to see a fair spike. and with infection I would expect a spike in BS, not a drop.....?

Never hold long acting insulin? What if a BS is 60? With even long acting insulin working within 1 to 2 hours...I would not give and speak with the doctor for instructions.

[txredheadnurse, BSN, RN]

Long acting insulin only causes incremental changes in blood glucose levels. It doesn't cause a large drop in the same fashion as short acting or even intermediate acting insulins. The purpose of the basal (note the word basal) insulins is to supply a steady release of small amounts of insulin over a 24 hour time frame. The constant spiking and dropping of blood glucose levels that can occur in type 2 diabetics by the constant use of bolus doses without also adjusting dietary composition, fluid intake and activity levels can be very stressful to the body.

[chrisrn24]

If you're worried about giving a long acting insulin call the MD and ask.

I say that because I held it one time without calling to okay the hold and it ended up being considered a med error. No bueno.