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Discussion

Insulin

Im having a issue with diabetes care in the hospital setting. All the diabetic pts are on sliding scale with meals and Lantus at night. It seems that we are not doing a great job with controlling pts glucose. I wonder why I dont see long acting insulin used for better control. It seems that sliding scales with meals is a little more reactive? I had a pt today admitted for hyperglycemia without ketosis a few days ago. She was on a sliding scale with meals with an additional standard dose of 35 units of humalog. Im trying to think this through. So if she was 120 she would get 0 units of sluding scale with the 35 standard of humalog. This kind of made me nervous. And she has no long acting insulin. Thankfully she returned from dialysis with a BS of 60. No humalog given. Called doc and I told him I would recheck after her meal..124!! No need to the give humalog... I guess I would like to hear from nursing experts on the correct way to manage our pts besides those sliding scales.. Are sliding scales the best practice?? Sorry so long but ...

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    Lantus is a long-acting insulin. Most of our hosp pts get lantus, mealtime short/rapid acting and a SS or blood sugars. SS insulin is not for meals, it is to cover blood sugars out of range before meals. If you have pts that are high, consistently, fast or 3 hours after eating, usually the basal insulin (Lantus,Levemir) should be looked at.

    We do not give oral anti-diabetic meds on a surgical floor, so most are set up with SSI and then monitored from there. It all depends on the pt, how resistant/well-controlled, T1 or T2 (obviously).

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    I'd also like to add that when patients are ill and under stress (like in the hospital) their blood sugars can go very crazy especially if they are getting certain other meds like steroids. You're basically chasing it all over the place but it won't be stabilized until the patients body is stable.

    I always wondered why blood sugars were never good in the hospital as well.

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