I posted an answer to you about your question to me only to find the thread closed.
I was talking about the one who said hold insulin for a bg of 75, which I disagree with, not 45
Diabetics don't make insulin and a person with a healthy normal appetite needs insulin and shouldn't have insulin held for long. Even the person with the 45 blood glucose may needs his doses readjusted but not necessarily held.
Always under the direction of protocol and md orders. It's not an exact science. A patient with a 45 bg can eat and shoot up to 400 without insulin. Another patient will crash even if he eats.
Am I being more clear. Anyone can feel free to put their input as I'm not the experts. And please ask questions if you have any more.
May 30, '04
I think your point is clear. I know "Our Policy" with anyone on FSBS is pretty clear below 60 if conscious give 4oz OJ or Regular Soda, if unconscious give i amp D50 recheck FSBS in one hour either way.
Depending on the type of insulin you may not want to hold it. I would certainly delay administering regular insulin in someone with a FSBS<60. In either case I would probably have the conscious Pt eat and drink Oj or Soda and then on recheck if he was climbing administer insulin NPH,70/30 etc. if Regular was ordered I would call and CYA verify the order.
May 30, '04
I once had a pt when I first got my license that got something like 19 units of NPH at 9pm, so of course when the next dose was due at 6am the pt was always <60, the the 11-7 nurse would hold the insulin and tell 7-3 nurse in report. The pt didnt always eat well, and if she ate bfast the logical thing would be to go ahead and give the 6am dose of insulin at 7am, well the 7-3 nurse wouldn't ever go back and re-check on pt so when I, 3-11 nurse, got there the pt had been without insulin all day and the bs would be high, really , really high. After several weeks of this, and no change of orders from doc even though he had been notified several times, I came in and pt bs was so high my monitor couldn't read it, so I called the doc who refused to give orders because if "we would give the insulin as ordered ...." so I told him that he would either give me an order, or come sit at pts BS and assume responsibility for her care, or I was calling 911 for the pt to go to ER and that he had 5 minutes to call me back and tell me what he wanted to do, then I hung up.He called me back with insulin orders, and the next day came in and wrote new orders with sliding scale insulin.
Just thought I would add my .02.
May 30, '04
I would not ask for an order to hold scheduled insulin for a BS of 75 IF the patient was able and willing to eat breakfast and IF I can make sure that the patient will get their food in a timely matter. Occasionally we have problems with not getting patients their trays delivered and their meals can be delayed for over an hour.
I agree with Tweety. It is not an exact science because of the way people vary in their complience to their diet- the timing of thier meals- how much they have been eating-meds like solu-medrol, ect. These factors can make a difference.
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