insulin help!!

WSU_Ally_RN, BSN, RN · Nov 21, 2011

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.

realnursealso/LPN, LPN · Nov 21, 2011

Trying to be very nice here, but WOW. Why are you asking us, you should have a talk with your charge nurse at work, don't ask on a web page. Please discuss this with the appropriate person at work. Insulin doses always have parameters, and if they don't your level of education should be telling you to call the doctor.

mandaaRN · Nov 21, 2011

Didn't realize my post is a bother to you. Isn't this site for nursing advice and questions. I'm a new nurse, and criticizing my level of education is highly wrong on your part. Don't answer my post then, I was jusy clarifying what I meant.

rn/writer, RN · Nov 21, 2011

No need to take offense. We're all trying to tell you that parameters are a normal and expected part of every insulin order. It has to be that way. Insulin has to be tied to objective data or we'd all be guessing when to give or to hold. That's for the patients' protection, obviously, but also for ours, as well. If you are seeing orders without parameters, maybe that's something that needs to be corrected overall.

I think what the previous poster was saying is not that you're a bother but that as a new nurse, you should be going up your chain of command and keeping your search for information as localized as possible. Because you don't have a lot of experience, you may not have the ability yet to distinguish correct information from other things that sound good but aren't right. And think about it. Doesn't it sound better to say, "I did this because my charge nurse said that's what I should do," than to say, "I read it on an Internet site."?

We also might, with the best of intentions, give you direction that varies slightly from your facility's P&P. It might not technically be wrong, but it if it violates the standards for your hospital, you can still find yourself in trouble.

You are right to ask questions. And it's not such a terrible thing to ask us. But use us as a starting place and verify everything first hand for your patient's sake and your own.

xtxrn, ASN, RN · Nov 21, 2011

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

Call for parameters. You can do that :)

It's very different for each person...example- my grandma gets shaky below 90....I've been in the upper 30s and still able to get to a glucose source. I NEVER hold my Lantus.

Also- check your facility policy and procedure on this - if the state or JCAHO (or whatever they've decided to call themselves) comes in, they want to know the policy...

tokmom, BSN, RN · Nov 21, 2011

Yep, call the MD. Forget the charge nurse. She should tell you to call the MD:lol2:

Like xtrn said, all people are different. Some get symptomatic at a 100, and others are fine at 50. If it were me, I would call the MD for some sort of paremeter and even ask if they want the lantus dose lowered a bit. Like rn/writer said, the Lantus is a basal insulin. It mimics how the pancreas would function if it could. The doses of insulin we give as in sliding scale once again mimic the pancreas. After we eat something the pancreas gives us 'squirts' of insulin to keep our levels even. The sliding scale is the artificial version of that.

This is why it is important to call the MD for parameters. When you are responsible for being the artifical pancreas, you can drop those levels in the toilet if you give too much with an already low glucose and a patient that may or may not be eating too well.

Makes you wonder how that funny shaped organ does what it does so well, doesn't it? The body is an amazing thing. :yeah:

QuenymamiRN · Nov 21, 2011

I agree with xtxrn, we had a Rt that would become unconscious with a blood sugar in the 90s. Another Rt needs oj and carbs if her blood sugar is below 130 because that is too low for her and she will be symptomatic. While a BS of 50 is normal for some.

SHGR, MSN, RN, CNS · Nov 21, 2011

Personally I think it's great that we have a pretty much anonymous forum here to support each other as nurses. Some new nurses- and I was one once- didn't always have a safe place to ask questions and even find out what questions to ask.

That said, I have a few things to add- even if there are not specific parameters for a patient's BG, you should have a facility P&P for hypo and hyperglycemia. Memorize it along with the chest pain protocol and SOB protocol and all of those. They are there to protect your patient and you!!

Also, the poster that said above about ask the patient, that is a good starting point to see how sensitive the patient is to his or her insulin (most of the patients I work with are Type 2's so they can use 300+ units a day! and then the Type 1's are using so little...it's scary) but a patient's needs can differ a lot in the hospital- different food, being ill, etc affect it a lot.

Keep learning and asking questions.

xtxrn, ASN, RN · Nov 21, 2011

New diabetics are especially at risk for hypoglycemic symptoms since their body is used to really high numbers- the "normal" numbers cause problems for a while. I was running around near 400 (and didn't know it until a pre-employment physical at a hospital I'd worked at before- the employee health nurse called me up to look at my plain UA- glucose was 389- random). I felt funky at 150 until I got my sugars under control. I was able to control it with diet alone for 12 years--- patients also need to know that insulin does not equal failure; diabetes is progressive. :) And insulin is much more freeing than I thought it would be. :up:

psu_213, BSN, RN · Nov 21, 2011

Didn't realize my post is a bother to you. Isn't this site for nursing advice and questions. I'm a new nurse, and criticizing my level of education is highly wrong on your part. Don't answer my post then, I was jusy clarifying what I meant.

I didn't see any post that said you were a bother...on an inpatient unit, our MAR said for lorifice "Do not hold if pt is NPO." For every other insulin there were parameters listed (even pre-meal, "non-sliding scale" doses). If there are no parameters, call the MD. If they give you grief about it, ignore them.

joanna73, BSN, RN · Nov 21, 2011

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

If you aren't sure, I would clarify with the Dr., or your Charge nurse. I personally would make a quick call to the Doc. Saves any confusion. Really, this is not the place to ask such an important question.

dudette10, MSN, RN · Nov 21, 2011

I have run into the same issue as the OP. We have a hypoglycemia and hyperglycemia protocol, plus parameters for sliding scale, but that's it. We never consistently get paramaters for preprandial insulin. I've asked other nurses on my unit, but they hold Lantus quite often, and that never sounded right to me.

I went to my diabetic educator. She was a great source of info. She probably knows as much or more than the attendings about diabetes management. We don't always have an endocrinologist on consult.