insulin per sliding scale

Anoetos, BSN, RN · Nov 10, 2012

Do you give insulin as indicated per sliding scale even if the pt is put on NPO? Like, Bld glucose is 300 and needs 9 units of Insulin. But pt is on NPO. Thank you

I would not give Aspart for coverage, but I would probably give Lantus.

In either case, I would note it in the MAR.

turnforthenurse, MSN, NP · Nov 10, 2012

Look at your hospital's policy and talk with the physician. Where I work if a patient is NPO, sliding scale typically isn't held. The patient may also have a dextrose solution hanging as well. If you feel uncomfortable giving 9 units per sliding scale, talk with the physician as they may adjust the dose.

kirschbalb · Nov 10, 2012

Thanks lot !

Anoetos, BSN, RN · Nov 10, 2012

For many hospitals, there won't be a policy, it's a nursing judgement issue. There is a protocol for what to do if BS is outside of certain parameters, and for a pt with a specific Dx of DKA/HHNKS, but for a pt with IDDM who just has a high BS, the decision to give or withhold insulin is often left up to the RN.

It's funny though, we learned the "normals" in school, but in the unit, a BS of 300 might be pretty therapeutic for some...lol

kirschbalb · Nov 10, 2012

Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?

Anoetos, BSN, RN · Nov 10, 2012

That IS interesting if you're talking about meds like Metformin. I was taught to never hold those. There must be some other reason. Is this patient undergoing a blood sugar challenge of some kind?

MrChicagoRN, RN · Nov 10, 2012

Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?

In addition to an acute disease state (or post op status), the patients activity & dietary patterns are altered while they are there. It's easier and safer to regulate their glucose status with a sliding scale insulin

Sun0408, ASN, RN · Nov 10, 2012

I give the SS even when NPO. With a BS of 300, they will likely not bottom out. If they were borderline, I may hold the insulin. Most pts that take metformin at home are held in the hospital setting;it is easier to control BS with SS like previous poster stated.. It is also not friendly with contrast etc so its safer to just stop while in the hospital.

tokmom, BSN, RN · Nov 10, 2012

We always hold metformin in the hospital due to possible contrast issues and like others said. It's easier to control the pt.

As for the NPO, sliding scale, at 300, I would talk with the MD to clarify, but I'm a CYA person. I don't think 9 units would drop a pt too much, but again it depends on the pt. Some pts can be symptomatic at a 'normal' number. I had pt that was a 100 and was symptomatic.

I would look at their baseline and go from there. You also need to take in account their IV fluids.

As for any long acting insulin, we give and monitor accuchecks q6h.

turnforthenurse, MSN, NP · Nov 11, 2012

Another concern: I have noticed that oral hypoglycemics are withheld during hospital stay, do you have any idea?

Metformin can interact with contrast dye, leading to lactic acidosis. Oral hypoglycemics are typically always suspended when a patient is in the hospital, even if that is all they take at home. I believe you can resume Metformin use 48 hours after contrast dye.

decembergrad2011, BSN, RN · Nov 12, 2012

I have always seen oral anti-diabetics held as well while they are inpatient which actually can really throw off their numbers. Our sliding scales normally start at 150 and go to 400. I will hold until the 200s usually if eating 50% or less. It depends on the patient. I don't want to stick my patients for just one unit of insulin so I wait until they require a bit more. I also give insulin after they eat if they eat at all or have them drink juice if they're on clears.