Insulin Administration: Standing and Sliding Scales

blondy2061h, MSN, RN · May 4, 2014

Yes, though ideally the standing order should have a stipulation to say, "hold if

Gabby-RN · May 4, 2014

The patient would get 8 units before eating dinner according to how the order is written. You would not wait to see if the patient actually ate all of their dinner.

dudette10, MSN, RN · May 4, 2014

You are correct. In addition, do you have a hypoglycemia protocol? Ours says to hold all insulin administration if glucose is less than 70, even if the standing dose does not have parameters.

yogastudentRN · May 4, 2014

There shoulda also be protocols for hypo that include any necessary adjustments to the usual 8u

Rags2Riches RN · May 4, 2014

This should be dependent on your facility's policy & procedures, patient condition & your nursing judgement. Personally, I would call the doctor before administering the standing dose with a bsg of 89.

MunoRN, RN · May 4, 2014

This should be dependent on your facility's policy & procedures, patient condition & your nursing judgement. Personally, I would call the doctor before administering the standing dose with a bsg of 89.

Why would you call the MD for a BG of 89?

Rags2Riches RN · May 4, 2014

Why would you call the MD for a BG of 89?

Perhaps I should have been more clear. I would call the MD if I was uncomfortable giving a standing dose of rapid acting insulin depending on the patient's condition. If the patient has had a poor appetite or there is a pattern of the patient's blood sugar dropping significantly after administration, I would call to see if they want to make adjustments.

classicdame, MSN, EdD · May 5, 2014

I am diabetic. Sometimes I take my rapid-acting insulin while I am eating, or immediately after. If you can magically be present during that time then you will know what the patient is eating. My suggestion is to follow the order, evaluate the patient after a meal to determine how many carbs were consumed, check BS 2 hours after a meal and give a snack if indicated. I would not hold the insulin unless they are not eating at all and then, of course, the MD must be notified.

blackdiamond407 · May 5, 2014

Thank you all for responding. If the BS is close to 60, I would personally call the doctor. Usually on our sliding scale orders it says call MD if sugar is 400. This particular patient has had a poor appetite lately so we typically wait until she has almost finished a good portion of her meal before administering rapid-acting insulin. Even if you ask her if she will eat what's on her plate, sometimes she will say yes and then eat nothing which is why we wait to see how much she will eat. I've noticed sometimes it's hard to know what to expect with a diabetic's BS because they can be so unpredictable. For example, I have another patient whose BS can be in the 70's before a meal. He has a pretty hefty dose of insulin ordered. When you check his sugar before the next meal it can be in the 300's even if he only ate 20% of his meal. I am beginning to realize that each diabetic's insulin protocol can differ drastically based upon how their body responds to both the insulin and the meals in which they eat.

nynursey_ · May 5, 2014

Of note, I've seen a few physicians lately writing orders for carb counting insulin as opposed to a standing order. For example, I had a patient last week who was ordered a sliding scale dependent upon pre-meal BS reading, and then it allowed for the patient to carb count to determine additional coverage. I suppose that only works when it comes to responsible, knowledgable diabetics … but if nurses are educated in carb counting, it could be helpful in eliminating the guesswork of choosing insulin doses.

NurseQT · May 5, 2014

I would update the patient's attending MD on her poor intakes. He or she may want to adjust the insulin dose..