Check a blood sugar before giving Glucophage?

[Morainey, BSN, RN]

Hi all,

Do you check a blood sugar before giving glucophage/metformin? One of my preceptors never said anything about it, and I assumed that since the pt took it at home, his diabetes was non-insulin dependent, and he didn't have fingerstick testing ordered, that you didn't check a blood sugar before giving. Then, a different preceptor was like, why didn't you check the patient's blood sugar???

Followup note, I asked in our acute care med surg class (I'm a new nurse) and the staff education nurse said that she had never heard of checking BS before glucophage, and no one else in the class had either. Our med guide on the floor says to monitor pt's blood sugars during administration but isn't more specific than that.

[Christy1019, ASN, RN]

if the patient is admitted to the hospital and they are diabetic they should almost always be on some form of tight glycemic control protocol and will be scheduled to have their blood sugar checked before meals and at bedtime. If for some reason they are NOT on a glycemic protocol I would still check their blood sugar prior to med administration. Granted, metformin is not a diabetic medication known to drastically drop blood sugars, and can also be prescribed for weight loss and polycystic ovarian disease w/out history of diabetes, however I was prescribed it for weight loss and was told I "wouldn't have to worry about becoming hypoglycemic", and that very day I took it w/out eating and within a few hours i was diaphoretic, trembling, irritable, disoriented. Besides, if you are giving it to a diabetic patient, don't you want to know what their baseline blood glucose is anyways? When in doubt, always do the extra step.

[Lisa Weyland BSN RN, BSN, RN]

Was the Glucophage a new Rx? Are their blood sugars controlled with insulin as well? Are they on any other new medications that could affect their blood sugars as well, i.e. prednisone? How is their PO intake? This is where nursing judgement really comes in handy. If the pt is in the hospital, they most likely should be on a glycemic protocol anyways. I think it's important to check a blood sugar at least QD in the AM for all diabetics. I can't count how many times I've had a patient with decreased FSBS checks to Q M/W/F QAM or BID because the patient is stable. Next thing you know, they are sick with the flu or something and they have decreased PO intake. Their Glucophage dosage could easily be over-compensating their insulin production, resulting in really low blood sugars. The patient might need to have the dosage decreased or DC'd completely. When it comes down to it...it is better to be safe than sorry. Just always ask yourself, Why is this person on this med? Why do I need to take her FSBS? What factors affect her FSBS and her medication? Nursing is 90% mind games.Good luck, I hope this helps.:)

[freda_o]

i always check blood sugar before giving any diabetic medication, PO or SQ. would i give a blood pressure medication without checking what the blood pressure is before?? nope. i consider the pt's med regime, whether they're just on PO or both PO & SQ medication, what they're eating pattern is, what time they're next meal is, whether they're NPO, and their blood sugar trends, etc...hope this helps :)