Is this common?

  1. 0 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
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  3. Visit  Finallydidit} profile page

    About Finallydidit

    50 Years Old; Joined Nov '09; Posts: 137; Likes: 122.

    17 Comments so far...

  4. Visit  morte} profile page
    0
    I'm thinking that the doc who wrote these orders is not an endo.....metformin is common given with a meal, and, yeah the s/s is odd for the h/s dose.....i would check with the attending/endo
  5. Visit  michelle126} profile page
    0
    No that is not common. I've never given metaformin at hs and our sliding scales don't start till the 130s. I would be calling the doc asap to get a clarification.
  6. Visit  classicdame} profile page
    0
    recommendations per Am. Academy of Endocrinology begin at 120 (in acute care setting) for correctional doses of rapid acting insulin but NOT hs due to possibility of hypoglycemia while asleep. Novalog generally prescribed with a basal insulin to PREVENT hyperglycemia as opposed to just treating it. Sounds like MD is not familiar with ADA and AACE guidelines. I would confirm to prevent low BS. BTW, 10 units of Lantus is like spitting in the ocean. Needs to be prescribed per weight.
  7. Visit  Finallydidit} profile page
    0
    Well I did ask the NP who was there yesterday, and she simply replied that she would go over all of his new orders when she came back on Friday..... It was like HELO, did you not hear what I just told you??? Sometimes nursing gets sooooo frustrating.
    I have 14 diabetics on my hall of 30. None of them get metformin at HS and none of them get insulin if their BS is wnl......
    I had to give this Res. 6 units last night for a BS of 155. I have never given him more then 3 units ever, as his BS rarely over 200. Of course he is already on alert charting, but I reported to the oncoming to keep a close eye on him because this really just doesn't feel right to me.
  8. Visit  morte} profile page
    2
    Quote from Finallydidit
    Well I did ask the NP who was there yesterday, and she simply replied that she would go over all of his new orders when she came back on Friday..... It was like HELO, did you not hear what I just told you??? Sometimes nursing gets sooooo frustrating.
    I have 14 diabetics on my hall of 30. None of them get metformin at HS and none of them get insulin if their BS is wnl......
    I had to give this Res. 6 units last night for a BS of 155. I have never given him more then 3 units ever, as his BS rarely over 200. Of course he is already on alert charting, but I reported to the oncoming to keep a close eye on him because this really just doesn't feel right to me.
    1) The squeaky wheel gets the grease.
    2) Would the "reasonably prudent nurse follow those orders?
    nialloh and Finallydidit like this.
  9. Visit  Finallydidit} profile page
    0
    Quote from classicdame
    . BTW, 10 units of Lantus is like spitting in the ocean. Needs to be prescribed per weight.
    Exactly, I don't think the lantus really made that much of a diff. During the course of a week on his old s/s I prob. gave insulin 3/10 finger sticks. 95% of the time only 1 unit. So I just don't get the need for 2 units at 100-120

    I would really like to understand this... I am going to call his Dr. tonight
  10. Visit  nialloh} profile page
    0
    Unless the pt is very fragile, I wouldn't give it. While I have done it, the pt was being closely followed by an Endocrinologist. This doc was being called at all hours with updates (per his order). But this wasn't a permanent order, and the pt was in acute care. Your order is just too dangerous IMHO.
  11. Visit  CapeCodMermaid} profile page
    0
    We have a resident who goes to the Joslin for her diabetes. They believe in extremely tight control. Her sliding scale starts at 100. That seems to be more common for our younger residents (she's 53). The older folks usually don't get coverage until their blood sugar is over 150-200.
  12. Visit  marissa795} profile page
    1
    I have definitely seen sliding scales starting at 100... mainly in acute care/med-surg floor settings. Their really big on tight glycemic control although there has been new research based evidence suggesting this is not always beneficial.
    makes needs known likes this.
  13. Visit  cebuana_nurse} profile page
    0
    Most of my old residents sliding scale begins at 150-200. The young ones (in their 40's-50's) has a sliding scale of 99-149. Though I haven't given a Metformin at HS. Most Metformins are given in the AM or at 1700. I agree to all that gave their opinions to call the doctor and get a clarification.
  14. Visit  michelle126} profile page
    0
    I would be making sure this person is getting a snack at night too.
  15. Visit  CT Pixie} profile page
    0
    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.


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