Published Nov 23, 2004
We have been using the Gluccomander for about a year now, a small laptop computer that has a program with a mathmatical claculation programed to titrate insulin gtts. We are now going to get rid of them D/T monetary retraints and I do not know if we will go back to the old hit and miss method we used to use or if we will just be expected to do the calculation as it was programed into the glucommander and we will just have to use a calculator or what.
What does everyone else use to titrate insulin? I would really like to know. Thanks Larry
We use a city wide Insulin gtt sliding scale protocol. If it isn't working for the patient, the doc increases from the standard scale to the aggressive sliding scale protocol, or decreases it if that may be the case. Still a hit and miss in my opinion...many don't fit into the box and you are having to call for adjustments anyway beyond the protocol. It is silly to have a patient's BG uncontrolled while on an insulin gtt. Of course there are some patients you can just not get controlled, but I think this protocol is still too wimpy....
before we went to the Glicommander we just had orders to titrate for FSBS, nurses discretion, if you wanted to increase 2units or decrease 2units whatever, the scariest thing about this for me is concern that some might feel 10 units is a good adjustment and others may feel 2 units is. I feel that the program we are using now is somewhat passive but at least it is regulated within reason.
We use an insulin gtt nomogram developed by two endocrinologists at our facility. After a loading dose of IV insulin, you take the current blood glucose then look to the previous blood glucose and multiply the current drip rate by the number beside the previous BS range. It sounds complex to explain, but it is really easy to use. It is the only way to order IV insulin in my facility and using this method are able to transition to SQ slinding scale usually within 48 hours even for people in DKA.
The sheet contains explicit instructions for how to titrate gtt and when to begin SQ coverage to prevent BS increases. All new doctors receive guides to ordering SQ insulin from the endocrinology department.
lil' girl, LPN
We use the sliding scale too.
Sliding scale with hourly checks.
Indy, LPN, LVN
There are different types of sliding scales too... low, moderate and high dose, also the critical care scale, and the "whatever the doc writes" scale. Example of physician written: blood sugar minus some number, all that divided by some number. The whole hospital tends to use the same sliding scale, so that if the doc writes "insulin coverage with low dose sliding scale", we know what to do with it. Doc can write his/her own scale if need be. The scales are kept posted at the nurses stations and the pharmacy prints the appropriate one out on the MAR too. Hard to miss it.
We base our insulin gtt on the Portland Protocol. Apparently, this is the scale our facility started with, and it got changed quite a bit to suit our needs. I wasn't working there when it started, but I have been there through some changes. Basically, it became much more aggressive over the years. I wish I had a scanner, I'd scan it to you. Maybe using the Portland protocol or the Atlanta protocol as a jumping off point and then work the protocols to suit your needs? You'd have to form a committee though!! Sheesh!! A LOT of work went into the changes, which included advanced nurses, floor nurses, endocrinologists, etc!! But what a difference it makes in blood glucose maintenance. Our goal is to keep patients below 150, they stay on the gtt for three days, and only come off if they meet protocol standards. Good luck! :)
We do have one Surgeon that writes FSBS-100/15 so a 255 say would be 155/15= 10.3333 so you give 10units I have only seen this as a Sq s/s tho our IV gtts orders prior to Gluccommander were like titrate Insulin to reach/maintain fsbs
For a while we were also going to initiate Insulin gtt on every CABG pt to promote good healing but it so far has only been used on diabetics having CABG
WOW!! Talk about work!! LOL We use it on every diabetic heart and any other heart that happens to run high sugars post op. Pretty soon, the gtt is going to be hospital wide for ANY patient with ANY surgery that's diabetic. I think it's a great idea, it really works!
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