can u believe it

[lovingRN2009]

had a patient with blood glucose of 140, had not been eating well. patient was due for 10 units of novolog, made call to md to check if dose should be decreased or held. md decides to order 20 units of novolog. (md had recently been out of town and covering md had decreased scheduled novolog from 15 with additional novolog based on meal intake to 10 units)can u believe this? 2 hours later patient had blood glucose of 58. after being notified he orders 10 units scheduled after meals with additional novolog based on meal intake, says even if patient does not eat with blood glucose of 58 give patient 10 units of novolog. i don't think so , this was happening right at the end of my shift. nursing was trying to find med director/administration to notify

[netglow, ASN, RN]

Somebody is out of his mind!

[Ruthiegal]

Holy cow!

[Tweety, BSN, RN]

Well, 140 is considered a high reading considering the patient wasn't eating well and maybe she/he knows the patient better than you. He probably striving for readings between 60 and 120. Diabetics need insulin.

Does sound a bit crazy though.

[chenoaspirit, ASN, RN]

That reminds me of the time I called the MD r/t patient's elevated PT/INR. She was voiding blood. The doc wanted to INCREASE her coumadin! It makes you wonder where some of them get their MD license, doesnt it.

[Pepper The Cat, BSN, RN]

Could someone please tell me what the normal range is? Here in Canada we use a different measurement - 140 on our scale you'd be dead! I find it really hard to follow these discussions when I don't have any idea what "normal" is using the American measurement system. Here, "normal" blood glucose is 3.7 - 6.3. (approximately, some MDs use narrower limets). Anything below 3 in trouble. Aboe 20 is also becoming worrisome.

Thanks!

[KneKno]

Found this at: http://www.reducetriglycerides.com/reader_triglycerides_conversion.htm

To convert mmol/L of glucose to mg/dL, multiply by 18.

To convert mg/dL of glucose to mmol/L, divide by 18 or multiply by 0.055.

These factors are specific for glucose, because they depend on the mass of one molecule (the molecular weight).

If you are a diabetic wishing to converse in American sugar lingo, the conversion is 18 or 0.055. For example, a blood sugar reading of 7.5 mmol/L

• multiplied by 18 yields 135 mg/dL
  
• divided by 0.055 yields 136.36 mg/dL.
  

... concentrations can be described by weight (in grams) or by molecular count (in moles). In both cases, the unit is usually modified by milli- or micro- or other prefix, and is always "per" some volume, often a liter.

This means that the conversion factor depends on the molecular weight of the substance in question.

• mmol/L is millimoles/liter, and is the world standard unit for measuring glucose in blood; specifically, it is the designated SI (Systeme International) unit;
  
• mg/dL is milligrams/deciliter, and is the traditional unit for measuring bG (blood glucose); all scientific journals are moving quickly toward using mmol/L exclusively; however, mg/dl won't disappear soon, and some journals now use mmol/L as the primary unit but quote mg/dl in parentheses, reflecting the large base of health care providers and researchers (not to mention patients) who are already familiar with mg/dl.
  

[lovingRN2009]

diabetics do need insulin. however, 20 units of novolog for a blood glucose of 140 is ridiculous. she has been at the facility i work at for over a month, believe me, i know her blood sugar trend. also, i hope he was not striving for the 58 she dropped to, and thank goodness the patient refused the ten units the dr. wanted her to have at that point!

[bamagt]

Why in the world would you ever call a doctor to find out if you need to hold a med or something???????? As nurses we should all know when to hold meds, especially something such as insulin.

In your case, I wouldn't have given it. A blood glucose level of 140 will not harm anyone.

[lovingRN2009]

as a nurse i do know when to hold a medication. in the facility i work at i need a physician's order to hold any medication. so when this situation comes up for you, you hold the medication even if the md wants it given, and there are no repurcussions?