Insulin/glucose checks

[Emilythenewgrad]

Hi everyone! So I work at a LTC facility and was the nurse on duty this evening. I have had this problem before at my place of work and and just want some opinions/ clarification.

I had a Pt who gets Apidra (fast acting insulin ) based on a sliding scale. When I went to check the pt blood sugar at 815pm it was 525. Based on the sliding scale I am to call Dr. if it was over 450. I called Dr. right away and he said to give 16 units, so I did.

Around 915 I went back and wanted to check my pt blood sugar again and it was 530 now! So I called Dr. because the pt was stating she felt a little weird but couldn't really describe it. As a new nurse, I wanted to be sure so I called. He said to just let it go and not check it again until morning and that it will take awhile for it to work.... her insulin is fast acting though.

My fellow nurses always tell me there is no need to recheck a blood sugar if it is high... only if it is low. I always recheck within 45 mins if a blood sugar is way high and I have ordered insulin. Am I wrong?

[Sour Lemon]

I always recheck critical highs. If I have to call the doctor for another critical high, I ask for a temporary Q2 order with sliding scale coverage until two or three consecutive results under "whatever".

[VivaLasViejas, ASN, RN]

I would never let a critical high blood glucose go until morning without rechecking after giving the SS insulin. What if it goes even higher? Not unheard of in brittle diabetics. I like Sour Lemon's idea.

[Buckeye.nurse]

You're not wrong. Waiting until morning hoping the blood sugar would go down could lead to a bad outcome for the patient. You acted prudently by re-checking, and calling the provider again. Sour Lemon had a great idea for the remainder of the night.