insulin help!!

nerdtonurse?, BSN, RN · Nov 21, 2011

I work in ICU, so we may be different, but we never get parameters on a standard scheduled aspart dose (8 units AC, for example). With AC/HS or q6h fsbs we do. I never hold Lantus unless the patient is DNR, actively dying, NPO, and is going into terminal hypoglycemia. And then it's more of a "I don't want this person's last conscious thought to be "OUCH!"

Having said that, I can't tell you enough that you need to know what your facility wants; every hospital, sometimes every floor or every doc is different. You may be supposed to "know" that Dr. Smith wants it held for a fsbs of 60 and you'd better not call him if you want to still have a backside, and "know" that Dr. Jones wants it given, even if you end up pushing D50 later. You've just got to learn what's the rules at your place.

littlewingrn · Nov 21, 2011

mandaarn-

Are you in an acute care setting or LTC?

SHGR, MSN, RN, CNS · Nov 21, 2011

I've asked other nurses on my unit, but they hold Lantus quite often, and that never sounded right to me.

It doesn't sound right to you- because it isn't! Lantus is basal insulin- think about it- most people take it at night. Your body needs insulin all the time for body processes. Doses can get titrated up or down though- it comes in small units to make this easier- and parameters exist too- the Lantus company puts out guidelines for home; there are research-based ones that we made standard orders from for our clinic. Most people will take the full dose even before surgery, or sometimes a reduced dose.

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.

Great idea! I became a CDE this year so I could do this for our staff and patients and I still ask a lot of questions of the more experienced CDE's on staff. Maybe yours would do an inservice for the staff about the basal/bolus insulins. Blood sugar control is so important for hospital outcomes (wound healing, prevent infection, all that stuff that impacts cost as well).

tokmom, BSN, RN · Nov 21, 2011

It doesn't sound right to you- because it isn't! Lantus is basal insulin- think about it- most people take it at night. Your body needs insulin all the time for body processes. Doses can get titrated up or down though- it comes in small units to make this easier- and parameters exist too- the Lantus company puts out guidelines for home; there are research-based ones that we made standard orders from for our clinic. Most people will take the full dose even before surgery, or sometimes a reduced dose.
Great idea! I became a CDE this year so I could do this for our staff and patients and I still ask a lot of questions of the more experienced CDE's on staff. Maybe yours would do an inservice for the staff about the basal/bolus insulins. Blood sugar control is so important for hospital outcomes (wound healing, prevent infection, all that stuff that impacts cost as well).

May I ask how you became a CDE? It's something I'm interested in doing. Thanks!

maelstrom143 · Nov 21, 2011

I'm a new nurse and slightly confused. Should I hold AC insulin if blood sugar is below 70mg/dl but they are going to be eating a meal? Or would I administer the AC dose after the meal? As well as the lantus dose, what would I do? I just need advice. Thanksssss :)

I usually like to review previous days' FSBS trends in my patients and see if they have been getting their insulin as ordered. I also ask the patient what they usually do at home. This kind of gives me an idea of what I am looking at. Anything 70 or below for FSBS I call the doctor to clarify the order BEFORE administering the insulin, esp if patient has been having issues w/hypoglycemia. Having all the background info helps when the doc calls back and starts asking questions. I have often had doctors lower the dosage of insulin for intermediate-acting insulins when patients trending downward has not been addressed. I have also had doctors say, "give insulin as ordered." I then proceed to write precisely that as an order. Then educate the patient as to what is going on, why you held insulin, why you are now giving it, and answer any questions they may have. Oh...and monitor intake closely.

Also, if patient trending down and insulins have been held previously, make sure doc is aware. Sometimes they might not be and this helps them decide if parameters need to be revised for any particular patient. :twocents:

SHGR, MSN, RN, CNS · Nov 21, 2011

Tokmom, the place to start looking if you want to get certified as a diabetes educator is http://www.ncbde.org/ and look on the left hand side of the home page- there is a link for everything you need to know. PM me if you have more questions- :) (end thread hijack)

Blackheartednurse · Nov 22, 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.

I really dont understand the purpose of your post, the OP asked for advice and she has the right so. There are many experienced nurse on this website so I dont understand what is wrong with posting a clinical question on this website, I'm sure the rn will also check with MD and her supervisor, all she wanted was additional advise from more experienced nurses.

Merlyn · Nov 22, 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.

Some of us on this board forget that way back when, we were new nurses and made some of the same mistake "New Nurses" today make, only when we made them there was no internet. Nothing like this forum where you could pose a question on a smart phone and get the advice from nurses that have gone through the very same thing you are going through. So my answer to your question from experience when I was a water boy for Clara Barton in the War between the States is is always contact the MD. He is the one that wrote the order in the first place.

joanna73, BSN, RN · Nov 22, 2011

It's ok to ask for advice here. However, if you aren't certain about an order, that's something that needs to be clarified with the Dr, not with nurses on a website. You need to be absolutely certain with respect to orders and protocols. The OP might receive 10 different answers here. I need my orders clarified often. I call the Dr. I wouldn't ask here about any orders. There isn't any room for interpretation. That's the issue some of us have...it isn't the asking of advice per se.

xtxrn, ASN, RN · Nov 22, 2011

To hold Lantus is like turning off someone's pancreas..... :down:

But yes- as joanna73 said, you really need clarification from the docs YOU work with, OP. :)

QuenymamiRN · Nov 22, 2011

There are certain meds that do interact with Lantus. Coreg is one and causes hypoglycemia. A Rt at my job takes coreg and Lantus we did hold his Lantus a few times due to hypoglycemia and the doc changed the dose a few times. So, yes while you normally would not hold the Lantus there are times where you may need to. I should add this Rt has a sliding scale with coverage.

DixieRedHead, ASN, RN · Nov 22, 2011

OP, this is a hard set of circumstances. What you need is POLICY. Although this is not much help to you in an acute set of circumstances, it is an opportunity for you to approach your manager and get policy written to cover your hind end should this situation arise again (and it will, over and over again).

That being said, if you feel like you need to call, and your manager or charge nurse is no help, CALL. Trust me if the patient's blood sugar dumps and there is irreparable damage or death the doc will throw you to wolves like a piece of hamburger to save his skin and say you should have called. If you get a chewing, so what?