Question regarding insulin administration - page 2
by mappers 6,060 Views | 21 Comments
Another nurse told me something the other day that I have never heard before. I tried googling it and couldn't find anything either. He said that if you are giving insulin and you aren't sure when the pt will be eating, you can... Read More
- 1Jan 26, '12 by ShantheRNNever heard of it....and I'm a pumper myself. None of the hospitals I've been in as a patient, student, or RN have those rules either. If it's a correction factor/sliding scale, it wouldn't matter if the trays were there since you're only correcting the current BS. It's reasonable to assume patients would want their correction and mealtime dose in the same injection so waiting for trays makes sense (especially if you're using a fast acting insulin.)
I've been diabetic for more than half my life and I've never heard of this 50% junk. It wouldn't surprise me, considering how diabetic care in a hospital is inadequate for establishing/maintaining control - just my humble opinion, of course Hope this helps!
- 0Jan 26, '12 by CDEWannaBeI've had type 1 for over 30 years and have never heard the 50% rule.
However, in theory it should work. Your co-workers rule is just that if blood sugar is at least 160 (because 80 or above is safe) then insulin can get a headstart before food arrives. The only catch is that the patient would need to eat 15-30 minutes within getting the insulin or it could cause a low.
Another drawback is if the patient has delayed digestion because the meal is high carb or high fat then it could cause a low.
Like others have said, stick to giving insulin as ordered.
- 0Jan 26, '12 by Meriwhen Senior ModeratorQuote from mappersI've heard of it being done.Thanks, but that doesn't really answer the question. No where did I say I would do that. My question was has anyone ever heard of this. I guess your answer is no.
IMO, I wouldn't do it myself--I'd give the insulin as ordered or if necessary, contact the doc, explain what's going on with the patient and see if the doc wants to tweak the insulin dose.
- 0Jan 26, '12 by mappersThanks for the responses. This nurse has been a nurse a lot longer than me and worked in several areas. But this threw me when he mentioned it. Then I couldn't find anything on it when I researched it. I did find what Esme talked about, but that doesn't sound like what he was talking about. Meriwhen, interesting that you've heard of it, one other responders haven't. What area are you in? Maybe that's a factor?
- 0Jan 26, '12 by Meriwhen Senior ModeratorQuote from mappersDon't know if that affects it: I'm in psych and I've never personally seen it done at any of my facilities...though that's not to say there isn't some nurse or two in there doing it. But I've heard about it from med-surg nurses.Meriwhen, interesting that you've heard of it, one other responders haven't. What area are you in? Maybe that's a factor?
- 0Jan 27, '12 by classicdame Guidethere ARE different formulas for determing insulin doses, but most are based on weight and carbs. I have not heard of this proposed method and, since prescribing is not within my scope of practice, I would not administer. If I felt like the dose exceeded the need, I would consult MD
- 3Feb 1, '12 by nursemarionThis is what you would call a "rule of thumb", something gleaned from experience and work habits. This is not a standard of care. There are lots of these kinds of things in nursing passed down from nurses over the years. We used to look at the ears to determine if they were dying, for example. After you have been around a while you hear a lot of these, some that have no proof in science. Intuitively it makes sense, and probably some doctor or someone somewhere answered a nurse's question about whether to hold the insulin or not by telling them this.
I think this nurse was trying to reassure you. In some areas like LTC there are so many on meds that it is nearly impossible to give the insulins all at the correct time. So something like this is relied on as a rule of thumb- if the blood sugar is too low you need to wait on Mrs. B's insulin, but Mr. C is at 200 so it is ok to give it a little early. Save Mrs. B for last since she is only at 120. Plus the med nurse often has to help with feeds, so she really has to triage the patient meds.
I would never take this as science, but I don't think it is particularly odd either. These days we have more standards and guidelines to go by. In the past we often went by such rules of thumb.
- 0Feb 1, '12 by mazyQuote from 0402This is really interesting because we just had a patient come back from the hospital with these orders and we were all scratching our heads because we had never seen anything like it. That is, 1/2 the dose, not 1/2 the FSBG.I know that for many of our pts, we do 1/2 of the HS dose, based on it not being given with a meal, but we never 1/2 the FSBG and dose off of that- we use the actual FSBG and 1/2 the SSI dose (and then round up if it comes out to X.5). I have seen this type of HS dosing at more than one hospital.
But correcting the dose based on FSBG without a dr's. order is something I've never heard of.