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Discussion

Blood Glucose

What would a MD order if someone had a BG above 400?

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    It depends on many factors. No two MDs will order the same thing.

    1. Is the patient a type I diabetic or a type II diabetic?

    2. We already know the patient is hyperglycemic, but is he/she displaying any overt signs and symptoms of hyperglycemia?

    3. Is the patient already on a long-acting insulin such as Lantus (glargine) or Levemir (detemir)?

    4. If the patient is a NIDDM, are they on any oral antidiabetic agents (Metformin, Glipizide, Starlix, Actos, etc.)? If so, when did they last take their medicine?

    5. Is the patient snacking on high-glycemic index junk foods such as cookies, candy bars, and Twinkies?

    I once called to report a patient's blood glucometer reading of 496mg/dL at about 8pm. The doctor responded, "Don't do anything. His blood sugar will naturally drop as he sleeps during the night."

    During another instance with another patient who was under the care of a different MD, I telephoned the doctor to report a blood glucometer reading of 520mg/dL. After asking questions about the type of insulin that the patient was receiving, I obtained a telephone order to give the patient 25 units of regular insulin (Novolin-R) now subcutaneously and recheck the blood sugar in 60 minutes.

    So, it all depends on the doctor, the patient, the signs, the symptoms, the type of diabetic, and the meds they are taking.

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    Is this a newly diagnosed diabetic or a diabetic with poor management? I would imagine the physician would also order a HgA1C level. At our hospital we manage the acute phase usually with Humalog then try switching them to a home routine (such as oral antidiabetics or a longer acting insulin depending on the patient's type of diabetes). If they are a newly diagnosed diabetic or a diabetic with poor control we want to do education. We have a diabetic educator and dietician that will talk with the patients in addition to nursing.

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