Insulin administration

BahoRN · Apr 29, 2010

If the BS is within defined parameters (which in this case it is), go ahead and give the insulin, because it is the insulin keeping it there. Don't wait for your patient to get hyperglycemic before you give them insulin coverage.

Always ask the endocrinologist before you decide to totally withhold the insulin when blood sugars are in range.

Don't put your license on the line playing doctor!

chloecatrn · Jul 10, 2010

Nope. Lantus provides basal coverage and has, for the most part, pretty much no peak. The patient's running D5 and is in the 100s -- it's likely partially because of the Lantus.

That being said, if you're ever unsure, call the doctor, because you're going to have to get an MD order to hold the Lantus anyway.

Snickerdoodles · Jul 23, 2010

I would probably agree with giving the Lantus. As was said that is likely why their glucose is controlled. But it also depends on if this is a new dose/dose increase of Lantus? What is their D5 going at? Has their glucose dropped the past couple days? Is this poor appetite thing new? Are they getting solumedrol/prednisone? Are they one a sliding scale that can give coverage if they are elevated tomorrow? Better to correct a slightly elevated sugar than have it drop overnight. There is not always a clear cut answer. I do not agree with having to call the doc for a hold order. In most cases that is your discretion as a nurse. Our facility will also let us give a half dose of Lantus, like if the patient is going to be npo for testing in the AM. Again, up to the nurse. Trust your schooling and skills you have learned, this is why you went to school!

chloecatrn · Jul 23, 2010

I would probably agree with giving the Lantus. As was said that is likely why their glucose is controlled. But it also depends on if this is a new dose/dose increase of Lantus? What is their D5 going at? Has their glucose dropped the past couple days? Is this poor appetite thing new? Are they getting solumedrol/prednisone? Are they one a sliding scale that can give coverage if they are elevated tomorrow? Better to correct a slightly elevated sugar than have it drop overnight. There is not always a clear cut answer. I do not agree with having to call the doc for a hold order. In most cases that is your discretion as a nurse. Our facility will also let us give a half dose of Lantus, like if the patient is going to be npo for testing in the AM. Again, up to the nurse. Trust your schooling and skills you have learned, this is why you went to school!

Holding a medication is NOT in a nurse's scope of practice, nor is changing a dose. Changing a dose is prescribing. Holding a dose is prescribing, by changing the prescribed dose to zero units. If I hold a med, I call the doc right after and get an order, unless there are already hold parameters written as part of the previous physician order. Even if it's acceptable in your facility, I'd be shocked if it's not against your state Nurse Practice Act. Every time you choose to do that, you're putting YOUR license on the line.

wowza · Jul 24, 2010

Basal insulin should always be given (unless they are already profoundly hypoglycemic) even if the patient is newly NPO. The insulin that should be held if the patient is NPO or is eating poorly is the correction insulin that is given with meals (ie aspart).

Sunnysidegirl · Jul 25, 2010

I Just wanted to thank everyone for the input.

wowza · Jul 25, 2010

It makes sense to keep the basal insulin. So your body normally secretes some insulin at a basal rate whether you are eating or not. When you eat, it then revs up its insulin production. So the docs try to mimic this by giving some basal insulin and some correctional/meals insulin. So without eating, only the correctional needs to be held.

Now, if the patient is low after getting just the basal, or they are NPO and you have held the correctional (ie they are getting just the basal) then the basal dose is probably too high and it needs to be cut down.

Snickerdoodles · Jul 26, 2010

Hmmmm.. You are also putting your license on the line by give the medication if it is outside a safe level. Would you give Diovan or lopressor a low b/p? Why is it any different to "hold" this medication? I guess we will agree to disagree on this one.

FiduciaRN · Jul 29, 2010

When we get orders at the hosp I work at, all BP meds are written with parameters. ( Ex. Hold for systolic less than 100, or Heart rate less than 60). I always call the doc to let him know I held the med and why, but some ppl I have worked with don't bc they say well we have the permission to hold it anyway. As for the insulin, I never mess around with that either. Some docs will have you give the Lantus at night even if the fsbs is 85. Some will write for half the dose, while others want it held completely. I always call to make sure. I have noticed that some RNs I worked with will play dr and decide to do whatever they want, which is a huge pet peeve of mine. We have RN after our name, not DR before it!!!!