I need some help understanding the physiology of this...
Pt has widely varying blood sugars over 24 hour period. 300+ to 30s and 40s in late afternoon and early morning...no Lantus to speak of, and sliding scale coverage ordered ac&hs...eating well at meals. Electrolytes WNL (K 4.2), but BUN/Cr are elevated - initially 38/3.9, then it rose to 42/4.7 within 24 hrs...not a dialysis pt (yet). I understand why out-of-whack K+ can mess with blood sugar, but I don't understand a physiological reason for a pt to have such widely fluctuating blood sugars. Pt ended up getting four amps of D50 in a five hour period...BS was up to 250-300, then crashed again. We couldn't give pt any fluids b/c of all the fluid in lungs.
Pt's body ending having enough of that...before the fourth amp, pt became responsive only to sternal rub, Code White was called, pt went to a unit.
Can anyone shed some light? Any piece of the puzzle missing?
Hi I have a question. What if you check your pt's blood sugar and it's too high for the glucometer to register, (limit of glucometer is lower than 450) and this pt is on a regular insulin sliding scale. Aside from calling the MD, would you give the highest dose of regular insulin on the sliding scale as well? What else would you have to do?? I'd like some guidance on this! thanks!
ris - always retake the test, first. Call MD. Gather equipment to draw a venous sample, it may be ordered STAT. Do not give insulin until an order is received.
ris_03tdgz
38 Posts
Hi I have a question. What if you check your pt's blood sugar and it's too high for the glucometer to register, (limit of glucometer is lower than 450) and this pt is on a regular insulin sliding scale. Aside from calling the MD, would you give the highest dose of regular insulin on the sliding scale as well? What else would you have to do?? I'd like some guidance on this! thanks!