Diabetic patients

[Phillygryl, LPN]

Several of the clients in the facility where I work are insulin dependent and regularly have blood sugar readings in the 300's and above. What kind of care will I have to give them in the future, they get insulin coverage 4 times and day and a dose of Lantus at bedtime. This does not seem to be controlling their blood sugar!!! Are they in a permanent downward spiral healthwise because the diabetes seems to be progressing! Will they soon be amputees?

[nightmare, RN]

What kind of diet regime are these patients on?

[ChristineN, BSN, RN]

Or even, what kind of other medications are they on? Steroids, which many asmatics are on, will raise your blood sugar. Are they battling infections?

[WindyhillBSN]

What about glucophage or amaryl ac? Or a basal insulin w/regular. We check bg levels 250 and up Q1-2H, and give basal insulin until it comes down.:typing

[chevyv, BSN, RN]

What else have they been eating? I can't count how many times I've taken bs only to have residents tell me they ate a 'few' cookies. UGH!!! I go through this every single shift I work.

[Phillygryl, LPN]

It is an assisted living facility and the diet is not the greatest, in fact no matter what is served to the clients, they can leave the facility to go and get whatever food they want to eat!!!

[litbitblack, ASN, RN]

Sounds like they need some education and insuling adjustments. Sliding scale is only supposed to be used little or they don't have good sugar control. Maybe the lantus needs to be either increased or bid. Definately some education and physician notification

[blondy2061h, MSN, RN]

Rather than blame the patients like most people like to do, I blame the prescribers.

Most non-endocrinologists are really either lazy or stupid about managing diabetes, because, from what I see, they're not doing it correctly.

People who are truly insulin dependent (type 1s and type 2s with beta cell exhaustion), will never be well controlled on just Lantus. Lantus was always meant to be in addition to meal time insulin in these people.

Sliding scales are not effective. They are reactive, rather than proactive. If the person's blood sugar is in range before a meal, they don't get insulin. But do you really think it's still going to be in range after they eat that meal? Sliding scale insulin depends on a blood sugar already being high.

Ever realize all sliding scales are the same? Do they really think that a 400 pound man on steroids is going to respond to insulin the same way an 80 pound frail 90 year old will?

A much better method is to give Lantus, then give a meal time dose before meals based on the number of carbs being eaten that meal. For example, have dietary label carb counts on the meal, see what the patient eats, and give a dose right after the meal based on that. Then you're matching food to insulin. Much better method. You can add a sliding scale on top of this so you can still address high blood sugars.

And then there's the issue of why are will still using Regular? Regular is out dated. Humalog, which has been around at least 10 years, will lower blood sugars much faster and more predicatbly, and matches spikes in blood sugars from meals better.

A lot of doctors also seem to take patients off their home diabetes medications if they get admitted to the hospital. Uhm, bad idea. This may just be our doctors cause these meds don't work so well with chemotherapy. I can understand that.

A lot of our doctors also will do things like cut the Lantus dose in half if they have just 1 lowish blood sugar. Occassional mild lows are really necessary to get well controlled blood sugar in someone who is truly insulin dependent. They're not the end of the world. Many doctors and nurses are paranoid about hypoglycemia.

There are many well controlled diabetics out there. They're seeing endocrinologists and taking control of things themselves often. And they're generally not the ones in the hospital

[blondy2061h, MSN, RN]

Or even, what kind of other medications are they on? Steroids, which many asmatics are on, will raise your blood sugar. Are they battling infections?

Excellent point. And TPN!

[ChristineN, BSN, RN]

And then there's the issue of why are will still using Regular? Regular is out dated. Humalog, which has been around at least 10 years, will lower blood sugars much faster and more predicatbly, and matches spikes in blood sugars from meals better.

Blondy,

I thought your whole post was very good. I work on a pediatric endocrinology unit, and have to say, the above comment is very true. I almost never see Regular used with the kids (which are mainly Type 1) anymore. They are all on Humalog or Novolog (both are lispro) sliding scales. Occasionally I see a kid that gets 70/30, but that's rare. Most also get Lantus or Levimir at bedtime, some twice a day.

[blondy2061h, MSN, RN]

Novolog is actually aspart, while humalog is lispro, but they're essentially the same. Then there's glusine (Apidra) which is newer and also similar.

[country mom]

And then there's the issue of why are will still using Regular? Regular is out dated. Humalog, which has been around at least 10 years, will lower blood sugars much faster and more predicatbly, and matches spikes in blood sugars from meals better.

I call it Humulin RRRRRRRRR.

The analogues are much easier to work with and more predictable.