insulin per sliding scale - page 2

Do you give insulin as indicated per sliding scale even if the pt is put on NPO? Like, Bld glucose is 300 and needs 9 units of Insulin. But pt is on NPO. Thank you... Read More

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    Quote from kirschbalb
    Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?
    Metformin can interact with contrast dye, leading to lactic acidosis. Oral hypoglycemics are typically always suspended when a patient is in the hospital, even if that is all they take at home. I believe you can resume Metformin use 48 hours after contrast dye.
    MedChica likes this.

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  2. 0
    I have always seen oral anti-diabetics held as well while they are inpatient which actually can really throw off their numbers. Our sliding scales normally start at 150 and go to 400. I will hold until the 200s usually if eating 50% or less. It depends on the patient. I don't want to stick my patients for just one unit of insulin so I wait until they require a bit more. I also give insulin after they eat if they eat at all or have them drink juice if they're on clears.
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    In this circumstance I would certainly give the insulin, then check the glucose later in about 30 minutes. Food is not the only thing that makes glucose rise.
    0402 likes this.
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    We will give Lantus, but mostly hold Humalog if they are NPO. In fact, we wait until the food tray is in front of the patient before giving short acting insulins. I've seen patients in the 200's drop to 50 if they did not eat, and then we chase the problem with sugar to prevent trouble. Check with the Doc if in doubt.
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    We hold all oral anti-diabetics as well, d/t interaction with contrast dye.
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    In my experience, this was defined by a doctors order in each case of a pt being NPO. Sometimes the cut sliding scale doses in half, sometimes the wanted them held. Occasionally it was ordered to give their normal dose based on their blood sugar. If it was a large dose they were supposed to get and they were NPO, it would call the doctor. I would never independently hold the dose (i.e. just say "I'm not comfortable with large of a dose, I'm going to hold it.") Also, unless the order specifically said to hold or reduce their basal insulin (e.g. Lantus)--that does should be given.
  7. 0
    In my hospital sliding scale is always given because it is meant to cover whatever the BS is. Meal insulin is held if the patient is NPO because that is meant to cover a meal the patient is assumed to be eating.
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    In my hospital oral anti-hyperglycemics are not held just because they are in the hospital. The pharmacy takes in account diagnostic tests that require contrast and will profile or hold based on that. The physicians keep an eye on it, the radiology staff always question us on whether the pt is a diabetic. So there are multiple checks in place. Pt really need to keep up their oral meds if possible.

    When a pt is NPO, I will not cover if <200, otherwise I give less (i.e. give 5 or 6 when 8 is due). Sometimes it is a judgement call. But recheck the blood sugar if in doubt.

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