Insulin Error

There's no way you could lose your job for that. I would not give insulin to a patient who is NPO unless the patient is getting TPN or a fluid with dextrose. It is against a lot of facilities' policies, and it's just straight up unsafe practice, to give insulin (esp. short-acting) to someone who is not eating. The risk of hypoglycemia is just too high - but I think you've figured that out at this point from what happened the first night. Hyperglycemia is not a good thing and it needs to be managed, but it's less immediately dangerous to the patient than hypoglycemia. You did the right thing in holding the insulin the second time.

Was it long acting insulin?

Do you have parameters for holding scheduled meds?

Did the pt receive any new medications?

For a postop pt hyperglycemia can be as adverse as hypoglycemia.

Whenever I hold insulin I check blood sugar multiple times throughout the night q2hours minimum.

I don't know the clinical scenario, but I would be very hesitant to hold insulin for a BG >200. Maybe next time ask md for a reduced dose.

Lesson learned.

In the future definitely call the MD or on call and run the situation by them. That way you covered your orifice!

I don't know the details of your patient, but he wasn't on a sliding scale? Usually with my patients who are NPO and DM, they are on a sliding scale and would check how much insulin is needed per protocol of the NPO scale. I believe with ours, anything under 200 wouldn't need insulin, so a BS of 210 would have required some coverage. The patient would be on fluids with Dextrose during that time also.

I wouldn't expect you to lose your job over it, but it's a learning opportunity.

Yes you can give lantus insulin to a patient who is npo what was the insulin. You can hold a medicine based on judgement but you have to call md and get an official order to hold it is against the law negligence if you don't get an order. Next time follow chain of command your charge nurse then nurse manager etc.

Interesting seeing the different responses on this. I think the best advice would be to call the doc next time. I would have held it for sure though.

I would have called the doctor for a dose adjustment. Cover yourself, unless there were an specific order saying to hold all insulin. Sometimes reducing 2 or 4 units is enough to regulate, not causing hypoglycemia or hyperglycemia.

It is really interesting to see how different hospitals handle insulin differently. "Hold if NPO" is built into the orders for short-acting insulin where I am. There are no NPO sliding scales. I had my preceptor freak on me during orientation because I tried to cover a blood sugar over 300 but the patient had refused his evening snack. It's a little crazy to me that some places you'd have to have a doctor's order to hold a med, too - here we'd just flag it "clinical decision" and explain the reason why we held it in the notes, no physician order required.

OP - Maybe you should check your hospital's policies and procedures to see if they have a document about administering insulin. Now that I know there are such huge variations on what you should and shouldn't do, I'd say the only solid advice is to see what your hospital says!

In the future definitely call the MD or on call and run the situation by them. That way you covered your orifice!

I agree. I've had NPH doses decreased because blood sugars were so low and I've been nervous about the pt bottoming out.