Insulin...When/ When not to give

Nurses General Nursing

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I had an issue at work the other night that I just can't get over so I decided to ask you very knowledgable nurses. I had a diabetic resident who at dinner time started to have an upset stomach and was complaining of nausea. He refused to eat because of that. His predinner B.S. was 155 in which I did not cover him with any insulin because his is rapid acting and all of his doses are high (for 155 coverage is 15 units.) Well since he did not eat I held his insulin and his pills. I informed the supervisor of my actions in which she said that was ok just make sure that I documented what was going on. Well now its 1110pm and I am about to go home when the the NOC supervisor calls the unit and questions my actions. She states that I am not a physician and that I can not make the choice to hold a residents insulin. I explained the situation to her stressing the fact that he has not eaten anything and that he would be receiving alot of insulin. She said that it was ok, we would just monitor him closely and if he bottomed out they would give him something to eat. Ummmm, I'm sorry but does the work nauseous not mean anything to you. In the end I gave the 15 units and documented my butt off as to why. Was that the right thing to do and was what the supervisor said right? TIA

Specializes in Tele, ED/Pediatrics, CCU/MICU.

I was taught to sort of be "in the middle" on this one.... I must say, those diabetics sure give me stress!!

Recently I had a pt who had a morning BS of 56, and was ordered to get 3 po meds for type 2 diabetes. There were no paramaters in the order for "Call MD for a blood sugar level of..." since a sliding scale was not used. The sliding scales at my facility say to call for less than 60, so she was right on the fence.

I didn't give them, waited until she had eaten (she was a finicky one, I wasn't sure if she'd eat or not, didn't have much of an appetite,etc), rechecked her about an hour and a half after she had eaten, and then gave the meds. We were still within the normal time frame for the meds (this all took place before 1030) and the pt was safe.

However, in those situations, when we're dealing with insulin, it gets very, very tricky. PO intake is unpredictable, and I feel like sometimes we tend to forget that the body's response to stress is to increase the BS!

ON the other hand, it's never a good feeling when you have to push D50....

I'm sure this will be easier to "think out" when we have more experience.

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Specializes in med-surg 5 years geriatrics 12 years.

It can be a problem. After years in LTC I went back to the hospital setting. Had similar situation and my supervisor told me I needed an order to hold; okay I do that from then on. Now I'm back in the LTC setting and hear it from the on-call doc for calling on something that should be a nursing judgement call. But I have learned to do rechecks if I felt strongly that I was doing the appropriate thing re: insulin

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Specializes in M/S, dialysis, home health, SNF.

Even doctors aren't in agreement about whether or not they want called. The doc at the LTC where I worked did want called.

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Even doctors aren't in agreement about whether or not they want called. The doc at the LTC where I worked did want called.

a nurse is always better off covering their behind.

a doc who states s/he doesn't want to be called, will not defend you in the courthouse.

rather, s/he'll insist you should have known to call.

c.y.a.

always.

leslie

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I must say, those diabetics sure give me stress!!
It's even more stressful when you work in a nursing home and have 10 to 15 of these diabetics to monitor, in addition to the rest of your residents who require care.
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Let me reclarify something. Most floors have standing Diabetic protocol. and Standing Sliding scale protocol. I think i misread the post and started myself on a tangent..lol Our standing protocol was to notify MD if blood sugar was more than such and such! If BS was below the expected amount. You always use nursing judgement to treat signs, symptoms of hypoglycemia. Seriously if I have a Blood sugar of 50. I sure am the hell going to hold the insulin get my patient something to raise blood sugar and recheck! And I have had too much experience to know that most Docs are just going to tell you okay and not give an order, their going to tell you to recheck the blood sugar in 15 minutes. Then q4 hours

Okay maybe its just that I am a hospice nurse and left to think for myself way too often...lol

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