First time having a patient with diabetes

schnookimz · Dec 10, 2013

I have no idea what those blood sugar measurements are so I don't know when you would hold it according to parameters like that. Typically the doctor writes an order to say when to hold the medication. Are you in the uk?? What do doctors do there when they write orders?

Tammy90 · Dec 10, 2013

I am in canada! what blood sugar measurements do you use??? well i have the orders and it doesnt say much. Says blood glucose monitory- POCT qid. I just wanted to know exactly how i should give metformin or if you just give it regardless? It seems like I would have to wait for my primary nurse to take her blood sugars before I give it, I just wanted to make sure.

KelRN215, BSN, RN · Dec 10, 2013

This is an honest question- if you are giving meds as a student, why can't you check her blood sugar?

In the US, we measure blood sugar in mg/dL.

Pepper The Cat, BSN, RN · Dec 10, 2013

Canadian Nurse.

Metformin is different than insulin, you usually don't hold it.

For a blood sugar of 3 you would follow your hospitals protocol for hypoglycemia, make sure the pt eats and then give the med.

A blood sugar of 4 is considered normal. Normal is anywhere between 3.7 and 7.3.

I know at my hospital the lab will not give students the required access for glucometers. It's a pain in the butt, but it is what it is.

Lev, MSN, RN, NP · Dec 10, 2013

I will hold metformin if the patient's blood sugar is low in the morning

ArrowRN, BSN, RN · Dec 10, 2013

in USA they still use mg/dl units in which normal levels are 70-99 mg/dl which is 3.9-5.5 mmol/L per text book. You can't really ask that info on the internet because each state, in fact each hospital facility will have slight variations as to what is normal.

Also some doctors orders may have a specific range set for the patient. You should never give insulin medication without having a baseline blood glucose checked(even though some hospitals do not check). A contraindication to giving metformin is the patient is already hypoglycemic. It also depends on if it's a maintain dose once per day or a immediately release IR. Look it up in your drug book for specifics on administration. sounds like its IR and should be with meals. TIP: Make sure the patient meal is on the floor and ready to be given asap after giving the med. hope this helps.

Esme12, ASN, BSN, RN · Dec 10, 2013

I have no idea what those blood sugar measurements are so I don't know when you would hold it according to parameters like that. Typically the doctor writes an order to say when to hold the medication. Are you in the uk?? What do doctors do there when they write orders?

Formula for calculation of mg/dl from mmol/l: mg/dl = 18 × mmol/l

Formula for calculation of mmol/l from mg/dl: mmol/l = mg/dl / 18

[TABLE]

[TR]

[TH]time[/TH]

[TH]value[/TH]

[/TR]

[TR]

[TD]before breakfast[/TD]

[TD]3.9 - 5.9 mmol/l[/TD]

[/TR]

[TR]

[TD]before lunch[/TD]

[TD]3.9 - 6.1 mmol/l[/TD]

[/TR]

[TR]

[TD]hour after meal[/TD]

[TD]less than 8-9 mmol/l[/TD]

[/TR]

[TR]

[TD]two hours after meal[/TD]

[TD]less than 6-7 mmol/l[/TD]

[/TR]

[TR]

[TD]between 2 am and 4 am[/TD]

[TD]more than 3-9 mmol/l

[/TD]

[/TR]

[/TABLE]

http://en.mte.cz/conversion.php?mmol=4&mg=&count_it=1

krisiepoo · Dec 10, 2013

I know at my hospital the lab will not give students the required access for glucometers. It's a pain in the butt, but it is what it is.

Nope, we couldn't take it either but sometimes the NA's would scan their badge and give me the meter to do the checks

Tammy90 · Dec 10, 2013

Yeah, where I am from, they don't allow students to use the glucometer. Very annoying but meh. and thank you everyone who answered. I waited for my nurse to take her sugars before I gave it. But my nurse said that it isn't necessary but doesn't hurt to wait.

Thanks again! I don't have much experience with diabetic people so just was a little nervous

tokebi · Dec 13, 2013

Don't be nervous about diabetes patients! Just monitor blood glucose and follow the parameters that come with MD order. Also, very importantly, understand the pharmacology.

Metformin does not need to be held out of fear of causing hypoglycemia, because it won't. Metformin works by preventing liver from releasing more glucose into bloodstream. It also has other beneficial mechanisms that help in long-term management of glucose level. So, you don't want to interrupt normal administration of metformin.

Glipizide, on the other hand, is a diabetes drug that definitely needs to be held if serum glucose is on the lower side, because this drug actually stimulates pancreas to secrete more insulin. Therefore, it will cause further drop in glucose level.

Andoo · Dec 18, 2013

Just as one of the other members have said. It is normally not required to hold metformin, because it's mechanism of action is different than that of Insulin. Metformin is a drug that works with the liver to decrease glucose production, without lowering serum glucose levels. While insulin breaks down glucose and allows it to enter the cells for consumption (which decreases their glucose levels).

But again, always follow the facilities protocol. If they say with a glucose level of 3.0 it is okay to withhold biguanides, than bring it up with your instructor and see what she/he says. :) Best of luck!