D5 1/2 NS and insulin coverage

[Little_Mouse]

What are your thoughts?

Pt has a history of DM. Pt has a GT feeding which is being held for surgery. Pt on 1/2NS IVF. I called the MD and received an order to change to D5 1/2NS (I was worried about his glucose level). PRIOR to IVF change, his BS was 131 at 2100. Changed IVF at 2200. Checked BS at 0600 and it was 153 (Accuchecks are AC/HS). Pt has insulin coverage: Novolog 3 units for BS >150, so I gave it.

Gave report to AM RN. RN stated I should've held the insulin coverage because it was labeled a "high dose" coverage (low dose would've been only 1 unit of insulin for BS >150). She attempted to explain the reasoning behind it but I didn't get it. From my understanding, pt is on a constant dose of D5, so the insulin coverage (which I consider is a little amount) would be OK to give. Plus, I've been told by other nurses that bc the pt is on D5 it's ok to give the insulin coverage. I've given insulin coverage before to pts on D5 and never had a problem with hypoglycemia afterwards.

But I've been told otherwise by another nurse--she had a similar situation but the pt became hypoglycemic, so now I think she doesn't give coverage anymore...

What do you think? What would you have done? And what's your reasoning behind it?

Btw, the AM RN said she thinks the BS will go down to 80 by noon. I think it'll be in the 110-120s. I'm tempted to call around then and find out. I told the nurse that and she said "Don't worry about it--if anything I'll give the pt D50 [amp]"."

[birdie22]

Unless the blood sugar is greater than 200, my personal philosophy is NPO=no insulin. I always like them a little on the high side than on the low side. And when I have to list a reason on the EMR as to why I didnt administer insulin with a BS of 185 or something, I put 'Pt. not eating/NPO' or something like that.

[Nursey103, ADN, RN]

We have a sliding scale at my hospital & once pt is NPO we switch to doing the accu chks Q4. We have different algorithms & depending on which one it is, we would definitely cover the pt. For 153, I think we'd only give 1 unit but we definitely don't use our discretion with insulin...we follow the guidelines.

[bryanvale]

for me i will still still give the ordered dose..since in our hospital anaesthesia doctors will call for a consult for diabetic patients..then IM doctor will order for NPO and will put the patient in sliding scale.. and to check the BS q6h or more frequently if the BS is very high..and the doctor will also will order for ivf usually D5W at a slow rate..