insulin per sliding scale

  1. 0 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
  2. Visit  kirschbalb profile page

    About kirschbalb

    Joined Oct '12; Posts: 5; Likes: 2.

    17 Comments so far...

  3. Visit  Anoetos profile page
    0
    Quote from kirschbalb
    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
    I would not give Aspart for coverage, but I would probably give Lantus.

    In either case, I would note it in the MAR.
  4. Visit  turnforthenurseRN profile page
    3
    Look 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.
    amarilla, sapphire18, and FLArn like this.
  5. Visit  kirschbalb profile page
    0
    Thanks lot !
  6. Visit  Anoetos profile page
    5
    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
    brillohead, sapphire18, MedChica, and 2 others like this.
  7. Visit  kirschbalb profile page
    2
    Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?
    on eagles wings and sapphire18 like this.
  8. Visit  Anoetos profile page
    0
    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?
  9. Visit  MrChicagoRN profile page
    6
    Quote from kirschbalb
    Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?
    In 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 insulin
    on eagles wings, NurseMoi, MedChica, and 3 others like this.
  10. Visit  Sun0408 profile page
    3
    I 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.
  11. Visit  tokmom profile page
    4
    We 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.
  12. Visit  turnforthenurseRN profile page
    1
    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.
  13. Visit  decembergrad2011 profile page
    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.
  14. Visit  classicdame profile page
    1
    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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