glycemic control

Nurses General Nursing

Published

I am in need of glycemic control protocols, sliding scale protocols, insulin gtt protocols from other facilities so I can compare them to my facilities protocols and thus find ways to improve patient outcomes, improve education for patients and staff in my facility. I'm a fairly new nurse (2 yrs) and I have been chosen by the exec. admin. to be apart of the glycemic control committee. I am scared to death! We are striving for Magnet status in our hospital and today we have grand rounds plus a meeting in which bedside nursing staff (me) will present problems and solutions to our current every day practice to physicians, educators and administrators from other hospitals and universities. All of the sudden I don't even know my name! Thats how nervous I am! HELP!

thanks for listening!

Nurse Betty

Specializes in Med Tele, Gen Surgical.

Hi Nurse Betty! I'm a student nurse, but also have had Type I DM for 35+ years and I just had to do a project on a similar subject, so perhaps my research will point you in the right direction. Here goes:

1. This article talked about many of your areas regarding glycemic control, and it is specific to the pediatric population. There is also a link to the online learning module that staff RN's at SFMC took, so you can see an example of the training intervention used to modify insulin error rates. Wolters Kluwer Health

2. Here is a link to the clinical practice recommendations for diabetes care from the American Diabetes Association: Search in Clinical Practice Recommendations â€" DiabetesPro â€" American Diabetes Association

3. Same sight, link to different page for professional journals from the same organization that can be searched: Search in Journals â€" DiabetesPro â€" American Diabetes Association

4. And a specific article on reducing the incidence of severe hypoglycemia in the inpatient setting. This is a real gem and outlines the process of of implementing new protocols and all the fun stuff that goes with it (and gives a sample of the protocol used!): Wolters Kluwer Health

Best of luck to you, and thank you for taking this on. It is near and dear to my heart as a diabetic and future RN.

--Natalie

soxfan80

51 Posts

Does your hospital have a certified diabetic educator?

CharmedJ7

193 Posts

I did a pretty thorough lit review a few weeks ago on sliding scale insulin and inpatient management of diabetes. I'm sry I don't have the links handy, but if you go to pubmed or ovid and do a search on sliding scale insulin there's a lot of great reviews that come up.

My hospital has crap insulin management policies, my understanding is that ideally:

1) Most every diabetic should be on a prandial + long-acting insulin regime in the hospital or on their home meds if possible. There are formulas for estimating daily insulin needs (smtg like, .6U/kg for obese people and .5/kg for overweight, etc, smtg like that) and titrating goes from there as needed with half the needs given as long-acting and half given as divided prandial doses and then maybe a little SS thrown in as correction ONLY.

2) Ppl on FS for TPN should have their BS monitored for a few days but insulin should be added to the bag if their sugars climb and it should be gotten under control (ie, do not keep ppl on FS and SSI for weeks)

3) Never ever ever use SSI as mono-therapy in a diabetic!

-as a note, this is done all the time on my floor and it is extremely crazy-making and just awful really, pretty much useless and so non-physiological.

There seems to be controversy over things like halving doses as night or halving lantus with NPO, so let me know if you find a more definitive conclusion.

I'll be interested in watching this thread. I think poor inpatient mgmt of diabetes is a big issue, so it's great that you're getting to work on something so impt!

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