your experience w/ insulin gtts?

Long Term Care Columnist / Guide · Oct 14, 2003

That is a HUGE drop, and you're right to be concerned. I'd have notified the physician, and then checked FSBS Q 15 minutes after that, just to make sure the pt. didn't bottom out. With an established hx of DM, the sugars don't usually drop that quickly, but since this pt. had no such hx I'm not surprised she did so.

Is there a protocol used on your unit for insulin drips? Where I work, we only do these in the critical care unit, but I know there are some places that do them on the floors. If your department doesn't often deal with titratable drips, you definitely should have someone to walk you through it even if there is an established protocol; it's not brain surgery, but you have to know the basics (such as how to titrate the drip according to the FSBS, and what to do if it goes in the dumper!) and be able to respond appropriately. Sounds to me like your unit could use some inservicing......it's something you might want to bring up with your manager.

Me, I love the challenge of insulin drips, as I'm primarily a med/surg nurse; unlike many duties on my floor, this is something that requires critical thinking skills, and the rewards for getting it right are tangible. In the course of a 12-hour shift I've seen people with initial FSBS in the 1000 range get their sugars under control and literally come back to life---instead of being confused and hallucinating, they start making sense again as they feel better.

Good luck to you, and use this experience as a learning tool to help you expand your skills and knowledge base.

rileygrl11, BSN, RN · Oct 14, 2003

No, we don't have a protocol for insulin gtts. We just handle it as per the orders which can be different for each dr. We had orders for accuchecks q1 hr while the insulin gtt was infusing. I suggested to the night shift RN to do q15 min accucheck on her own as opposed to the hrly ones b/c I was afraid she would bottom out. The insulin gtt had sliding scale and for that range she was decreased from 8 ml/hr to 1 ml/hr with orders to stop once she was

I'll be interested to go into work tomorrow and find out what happened.

RNKPCE · Oct 14, 2003

At our hospital they go to CCU if they are on insulin gtt and need q1h fingersticks.

dprayvd · Oct 14, 2003

aaaaa

rileygrl11, BSN, RN · Oct 16, 2003

Thanks all for your posts.

glascow · Oct 17, 2003

I wonder if the initial blood sugar was correct. When we get a value that abnormal I will usually recheck it. Just a thought.

On the other hand, pts with HHNK usually have extremely high sugars and it doesn't take a whole lot of insulin to get it down, but they do need lots of fluid!

People who develop HHNK :

Type 2 diabetes mellitus (possibly undiagnosed)

Recent infection or illness

Recent addition of a drug, such as a corticosteriod, to the therapy

Recent surgery

certain types of cancer