Is this common?

[Finallydidit]

Okay have a 64yom, with qid accuchecks.. s/s 151-199 1 unit novalog.. He also recieved 10units of lantus @ 9p.

Sent Res. out to hospital for altered mental status, came back yesterday with lantus DCd, replaced with metformin q/hs, his s/s is now 100-120 2 units on novalog, 121-150 4 units, and 151-170 6 units.... Is it common to give insulin when the range is 100-120? Most of my Res. start at 130 to 180.

If this is common, can someone please tell me the rational behind it. I can perhaps see, if it was only before meals, but at bedtime Im not sure I get it.

Thanks so much

[CT Pixie, BSN, RN]

I have seen the sliding scale as low as 100 on two occasions in my two years in LTC. I had one very brittle diabetic on my LTC wing. That scale started very low, it was at 100 . And her sliding scale remained that way the 18 months she was on my wing until her death.

The other had gone out to the hospital for several things and came back with a really odd sliding scale. Her accuchecks had been really "off" for her. She came back with a sliding scale that started at 100 also. Her accuchecks seemed to level off and stay WNL and the the sliding scale was d/c'd to a higher range for coverage. I think it was 2-3 wks of that low scale before it was stopped.

As for the metformin, I work 3p-11p and I have never given it on my shift.

[SarasLPN]

At our facility SS starts at 200. Our medical director wants everyone on the same scale to help rule out insulin errors. However there are a few who have special orders.

[stelarRN]

i have a pt right now whose sliding scale starts at 70 (70-100, 2 units).

[Finallydidit]

NP came back in on Friday and after much encouragement agreed to change his s/s back the the 150-199 1unit, started him back on his lantus, but kept the metformin and yes she left it @ hs..... So who knows, at times I fell like I just work there!!! But I am very happy that she finally agreed to go back to his origional s/s

[morte, LPN, LVN]

NP came back in on Friday and after much encouragement agreed to change his s/s back the the 150-199 1unit, started him back on his lantus, but kept the metformin and yes she left it @ hs..... So who knows, at times I fell like I just work there!!! But I am very happy that she finally agreed to go back to his origional s/s

i was more concerned about the metformin at HS than the sliding scale, look it up in your drug handbook, "with meals" i think is what it will say.....if he is not low in the am, perhaps the metformin is NOT DOING ANYTHING.

[morte, LPN, LVN]

NP came back in on Friday and after much encouragement agreed to change his s/s back the the 150-199 1unit, started him back on his lantus, but kept the metformin and yes she left it @ hs..... So who knows, at times I fell like I just work there!!! But I am very happy that she finally agreed to go back to his origional s/s

i was more concerned about the metformin at HS...what was her rationale for that?