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- by kirschbalb Nov 10, '12Do 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
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- Quote from kirschbalbI would not give Aspart for coverage, but I would probably give Lantus.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
In either case, I would note it in the MAR.
- Nov 10, '12 by turnforthenurseRNLook at your hospital's policy and talk with the physician. Where I work if a patient is NPO, sliding scale typically isn't held. The patient may also have a dextrose solution hanging as well. If you feel uncomfortable giving 9 units per sliding scale, talk with the physician as they may adjust the dose.
- Nov 10, '12 by kirschbalbThanks lot !
- For many hospitals, there won't be a policy, it's a nursing judgement issue. There is a protocol for what to do if BS is outside of certain parameters, and for a pt with a specific Dx of DKA/HHNKS, but for a pt with IDDM who just has a high BS, the decision to give or withhold insulin is often left up to the RN.
It's funny though, we learned the "normals" in school, but in the unit, a BS of 300 might be pretty therapeutic for some...lol
- Nov 10, '12 by kirschbalbAnother concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?
- That IS interesting if you're talking about meds like Metformin. I was taught to never hold those. There must be some other reason. Is this patient undergoing a blood sugar challenge of some kind?
- Nov 10, '12 by MrChicagoRNQuote from kirschbalbIn addition to an acute disease state (or post op status), the patients activity & dietary patterns are altered while they are there. It's easier and safer to regulate their glucose status with a sliding scale insulinAnother concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?
- Nov 10, '12 by Sun0408I give the SS even when NPO. With a BS of 300, they will likely not bottom out. If they were borderline, I may hold the insulin. Most pts that take metformin at home are held in the hospital setting;it is easier to control BS with SS like previous poster stated.. It is also not friendly with contrast etc so its safer to just stop while in the hospital.
- Nov 10, '12 by tokmomWe always hold metformin in the hospital due to possible contrast issues and like others said. It's easier to control the pt.
As for the NPO, sliding scale, at 300, I would talk with the MD to clarify, but I'm a CYA person. I don't think 9 units would drop a pt too much, but again it depends on the pt. Some pts can be symptomatic at a 'normal' number. I had pt that was a 100 and was symptomatic.
I would look at their baseline and go from there. You also need to take in account their IV fluids.
As for any long acting insulin, we give and monitor accuchecks q6h.