insulin help!!

Always follow your parameters. They should be listed on the mar.

I'm not talking about sliding scale, the before meal dose

Even that shoul dhave parameters.

I would hold until after supper...personally.

Follow the parameters on the MAR or if there is none follow your protocol. At my facility for one Rt it states hold if BS below 55 and call MD. However, for others it doesn't have a parameter and we hold only if below 60 and call MD as per policy.

Before meals or after meals, when to hold when to give should all be order by the doctor. If it isn't call her or your supervisor.

I worked on a diabetes unit for years. If there is no policy or parameters given for a particular patient, do not hesitate to call the physician and ask for parameters. Every patient is a little different in how they react to their meals and insulin coverage. The physician may actually want to change the patients dosages (not just holding or giving after) if their pre-meal sugars are trending too low or too high.

Don't mess with the Lantus dose unless you have parameters that allow for it or you call the doc with a compelling reason and get an order to hold. Lantus is a long-acting, basal insulin that covers the entire 24-hour day. If you hold it, you will now be changing the start time of that dosing day to the next time it's given. Because Lantus offers even coverage (as opposed to the ups and downs of bolus doses of short-acting insulins), you don't need to be worried about throwing someone into insulin shock. Their dose should be calculated to provide steady coverage without causing them problems. Even surgical patients who are NPO usually get their Lantus.

Please, have a more experienced nurse show you what to look for in the orders if you aren't sure what you should be seeing. Also, check your facility's policy and procedures. Look in the standing order sets for different types of patients. Sometimes we look at standing orders so often that, after a while, we stop seeing all the details.

You can also ask a patient what they do at home. This can come in handy if the doc wants to stick with a successful regimen. But, don't ever use the patient's info as an order. They might not be taking their insulin correctly. Even if they are, you still need the official order.

You can also consult the pharmacist. They have reasons for the things they do, and they often know more than the docs (or nurses) do about meds and their quirks.

The thing with insulin is that you really have to know the actions for each type and how they perform in combination.

Best wishes.

If the docs gave parameters, I wouldn't be asking this question. They only give paramters for sliding scale. :/

You need to call and clarify the orders with the doc. What has the BS been trending before meals lately? They might need a dose adjustment, this is something that the doc would want to know.

I am only a nursing student, my advice? Ask your Charge nurse what to do!!!

The before meal coverage is to cover the carbs for that meal. If I knew the pt was a good eater and would eat their whole meal, I wouldn't hesitate to give it. If I was unsure, I probably would wait and see until they ate about half the tray, then give. If they didn't eat the whole tray, or didn't eat a good portion I would probably call the doc for hold parameters.