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]"." <---her implying that it will drop...a LOT. Hmm..ok....