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- by leigh_86us Apr 1, '12Silly question: would you give insulin to a patient who was NPO before surgery? It seems like the answer could be obvious, but I am feeling a little guilty. Scenario: Mr. Smith was an elderly, diabetic patient admitted at 3am for SBO on a busy night shift. BG in ER initially was 130. I wake up the groggy resident to call for admit orders, and I forget to remind her the patient is diabetic. She states he should be kept NPO for surgery in the AM. About an hour later, I realize I didn't get an order for BG AC&HS or a sliding scale. I grab a blood sugar, and it is 185. I ask my charge nurse if I should wake the resident up again for a sliding scale order, and she states he is NPO and the blood sugar wasn't that high, so I wouldn't be covering regardless. I was hoping the resident would be in early so I could still ask before I left, but they weren't so I ended up passing it on to dayshift. I feel bad now for not covering the patient.
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- Apr 1, '12 by Do-overLike so many things... it depends.
It would up to the physician, really. They can't be too high going into surgery, and more than food affects blood glucose. Usually, if I have an NPO patient with a 0700 BS that would normally be covered I just call the doc and see what they want.
- Apr 4, '12 by turnforthenurseRNYup, it depends. Our diabetic educators tell us to not hold their sliding scale (correctional) insulin, but hold their pre-prandial insulin. But again, this should be clarified with the doc. Some will tell you to hold insulin while others will tell you to give it.
- Apr 4, '12 by rn/writerBasal insulins are usually not withheld because they give 24-hour coverage. But other insulins have different actions and really should be addressed by a protocol, standing orders, ot patient-specific orders.Last edit by rn/writer on Apr 4, '12
- Apr 4, '12 by Sweet_Wild_RoseYou really should check with the doc. We've had some patients come down to surgery without having gotten any insulin for the last 16 hours- even though their AM blood glucose was over 300. Add in the stress of surgery, and then we're really fighting to get that glucose below our target of 150. Makes me wonder just how many surgical infections/complications could have been avoided if the blood sugar had been under control before surgery.
- Apr 5, '12 by turnforthenurseRNQuote from rn/writerBut based on the blood sugar, the basal insulin dose may need to be adjusted. The patient may not need all 50 units of Levemir if their blood sugar is 90. Call the doctor and ask and see if they will prescribe a reduced dose. This is another thing our diabetic educators tell us.Basal insulins are usually not withheld because they give 24-hour coverage. But other insulins have different actions and really should be addressed by a protocol, standing orders, ot patient-specific orders.
- Apr 5, '12 by rn/writerQuote from turnforthenurseRNBlood sugar may also determine whether the patient is given NS, LR or D5W in his/her IV.But based on the blood sugar, the basal insulin dose may need to be adjusted. The patient may not need all 50 units of Levemir if their blood sugar is 90. Call the doctor and ask and see if they will prescribe a reduced dose. This is another thing our diabetic educators tell us.
The unfortunate thing is that a lot of surgeons get skittish when dealing with diabetic patients. It's good when there are established protocols or a hospitalist or the primary care doc is involved and can manage the medical aspect of the patient's care while the surgeon concentrates on his or her area of expertise.
- Apr 8, '12 by VespertinasQuote from rn/writerAdding to the chorus of "it depends" I'd like to mention that my last facility had us give half the basal dose for next day ORsBasal insulins are usually not withheld because they give 24-hour coverage. But other insulins have different actions and really should be addressed by a protocol, standing orders, ot patient-specific orders.
- Apr 9, '12 by BluegrassRNPassing it on to the day shift would have been perfectly acceptable in my facility. We want our blood sugars to be between 140-180, according to our order sets. 185 isn't that far off. AM/preop labs will show her blood glucose, and if the doc wants to address it prior to surgery, he can.
- Apr 9, '12 by classicdameyou did not mention the type of insulin, although anything given on a sliding scale would probably rate a "no" to your question.
Basal insulin should not be stopped, even if patient is NPO (Lantus, Levimir and sometimes NPH if MD orders). The body needs insulin 24/7. THe stress of surgery will make BS rise.
If a procedure is of short duration, and glucose checks are frequent enough, addtional insulin may be ordered. Again, it would be the MD's discretion. It is not impossible for glucose or dextrose to be given IV during a procedure, but it is an "extra" thing to be monitored, so MD's much prefer the patient be in good control prior to the surgery.