diabetes protocol for LTC facilities

[wiley6coyote]

Hi there- I am new to this site and I posted a question in the general discussion which may have been better here.

I am interested in knowing the protocol in LTC facilities regarding diabetes management. At the home where I work, there is no protocol and the knowledge regarding diabetes management is poor. I had a resident the other day who had been vomiting on and off for a day ( type 1 diabetic) and whose BS was approaching low and no one had thought to bump up the testing, or encourage increased liquid carbs or even call the MD-(it was not even mentioned in report) Another thing I have noticed is it is common for staff to "hold " insulin because they feel the BS is low when in fact it is not- they are just unaware of the proper range. Do homes keep glucose tabs or gels available as an emergency or just glucogon?This is not the first time it has happened and I would like to initiate a protocol but am not too clear how to go about it. It was suggested by another reader to hire a nurse educator for the home on a contract basis. I am interested in the protocol's for other LTC facilities if anyone could give me a condensed version I would be grateful.

[CoffeeRTC, BSN, RN]

I would think that first off, critical thinking or nursing judgment should come into play. If you have a diabetic that hasn't eaten...the doc needs called or as a nursing measure...push fluids/ carbs as much as you can until you hear from the doc. High blood sugar is easier to treat than low.

As far as not giving insulin...um...that is a docs order, not up to nursing.

We do have glucose gel and glucagon for injection in our Emergency box.

Your facility needs to have a policy in place for when to give the glucose. If it doesn't...how about asking the pharmacy if they have one. Are you a chain facility or corporate based? maybe a sister place has one. Even independant places have consultants that come in and should be able to help you. Don't reinvent the wheel.

[jschut, BSN, RN]

We have nurses in our LTC that will not give coverage or Lantus if they think the person is too low at hs.

I will give them coverage needed and give them a snack at hs to help keep them from bottoming out.

I don't agree, but what are ya gonna do?

[siouxsieyq, BSN, LPN, RN]

The LTC I work at has protocols in place... Call MD if BS x, routine insulin has parameters to hold if BS below a pre set amount and all Diabetics get an HS snack... The orders are all obtained at admission, a little more work in the beginning but assists in creating BS control in the long run