to hold or give insulin?

[ViolinTreble]

j Had a patient npo who's bs was about 200s they were on sliding scale insulin which I covered with regular and also detemir. Accu checks were q6 hours. The previous shift was also covering the bs. My charge told me I was wrong in covering with the sliding scale and she got a order for half ns with d5. I don't agree with the fluids bc he was already so high. Was I wrong for giving the insulin? I was anyways taught to cover the insulin bc other factors besides food can elevate the bs. I even called the md who said to give it. So I guess I'm confused as to when to hold it and when to give it if their sugar is high. They were npo for a failed swallow exam.

[ViolinTreble]

The insulin thing is so confusing to me. Some ppl say don't hold it some say hold it. I know my charge nurse is really smart though but still so confusing.

[Momma1RN, MSN, RN, APRN]

It really depends on the patient. Because the levemir is long acting and the patient was NPO, the SSI definitely had the potential to bottom him out. And the NPO status further complicates things because if he got hypo, D5/10 would have been your only option. If the physician knew he was NPO, had gotten levemir and was to be covered with SSI for 200 and ordered you to cover him anyways, at the very very least I would have repeated a FSBS sooner than 6 hours. I think that it was good nursing judgement to question the order. If he were in the 400s, it would have been a different story I think. Honestly, don't look for a one size fits all scenario because things like this should be taken on a case by case basis. Use your judgement, and question any order you're uncomfortable with.

I gave a pt 100 units of U500 insulin last night. You better believe I spoke extensively with physician and pharmacy and was rechecking his sugar way more often than ordered.

[icuRNmaggie, BSN, RN]

I can not imagine giving that much insulin. That is terrifying. I had a pt in hypoglycemic coma/cerebral edema from self administering U500. He did not survive.

[Momma1RN, MSN, RN, APRN]

Yup. Unreal. Insulin resistant. There was a big discussion because he takes up to 25 units U500 before each meal according to his own sliding scale, but apparently he uses syringes that are calibrated differently than ours? The U100 syringes maybe? (I'm still a little confused about this) but apparently when he gives himself 25 units with his syringes at home, it's the equivalent of 1/5 of what we would give with our syringes. That's why it was such a high amount. Here I am thinking a unit is a unit is a unit. I double triple checked with the doc and pharmacist and rechecked his sugar, never got below 120. Of course he was at 500. Sorry for the hijack. Needless to say, no other RNs were super comfortable with the situation.