Is this common?

Specialties Geriatric

Published

Okay have a 64yom, with qid accuchecks.. s/s 151-199 1 unit novalog.. He also recieved 10units of lantus @ 9p.

Sent Res. out to hospital for altered mental status, came back yesterday with lantus DCd, replaced with metformin q/hs, his s/s is now 100-120 2 units on novalog, 121-150 4 units, and 151-170 6 units.... Is it common to give insulin when the range is 100-120? Most of my Res. start at 130 to 180.

If this is common, can someone please tell me the rational behind it. I can perhaps see, if it was only before meals, but at bedtime Im not sure I get it.

Thanks so much

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I'm thinking that the doc who wrote these orders is not an endo.....metformin is common given with a meal, and, yeah the s/s is odd for the h/s dose.....i would check with the attending/endo

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No that is not common. I've never given metaformin at hs and our sliding scales don't start till the 130s. I would be calling the doc asap to get a clarification.

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Specializes in Hospital Education Coordinator.

recommendations per Am. Academy of Endocrinology begin at 120 (in acute care setting) for correctional doses of rapid acting insulin but NOT hs due to possibility of hypoglycemia while asleep. Novalog generally prescribed with a basal insulin to PREVENT hyperglycemia as opposed to just treating it. Sounds like MD is not familiar with ADA and AACE guidelines. I would confirm to prevent low BS. BTW, 10 units of Lantus is like spitting in the ocean. Needs to be prescribed per weight.

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Well I did ask the NP who was there yesterday, and she simply replied that she would go over all of his new orders when she came back on Friday..... It was like HELO, did you not hear what I just told you??? Sometimes nursing gets sooooo frustrating.

I have 14 diabetics on my hall of 30. None of them get metformin at HS and none of them get insulin if their BS is wnl......

I had to give this Res. 6 units last night for a BS of 155. I have never given him more then 3 units ever, as his BS rarely over 200. Of course he is already on alert charting, but I reported to the oncoming to keep a close eye on him because this really just doesn't feel right to me.

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Well I did ask the NP who was there yesterday, and she simply replied that she would go over all of his new orders when she came back on Friday..... It was like HELO, did you not hear what I just told you??? Sometimes nursing gets sooooo frustrating.

I have 14 diabetics on my hall of 30. None of them get metformin at HS and none of them get insulin if their BS is wnl......

I had to give this Res. 6 units last night for a BS of 155. I have never given him more then 3 units ever, as his BS rarely over 200. Of course he is already on alert charting, but I reported to the oncoming to keep a close eye on him because this really just doesn't feel right to me.

1) The squeaky wheel gets the grease.

2) Would the "reasonably prudent nurse follow those orders?

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. BTW, 10 units of Lantus is like spitting in the ocean. Needs to be prescribed per weight.

Exactly, I don't think the lantus really made that much of a diff. During the course of a week on his old s/s I prob. gave insulin 3/10 finger sticks. 95% of the time only 1 unit. So I just don't get the need for 2 units at 100-120 :eek:

I would really like to understand this... I am going to call his Dr. tonight

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Specializes in IMCU/Telemetry.

Unless the pt is very fragile, I wouldn't give it. While I have done it, the pt was being closely followed by an Endocrinologist. This doc was being called at all hours with updates (per his order). But this wasn't a permanent order, and the pt was in acute care. Your order is just too dangerous IMHO.

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Specializes in Gerontology, Med surg, Home Health.

We have a resident who goes to the Joslin for her diabetes. They believe in extremely tight control. Her sliding scale starts at 100. That seems to be more common for our younger residents (she's 53). The older folks usually don't get coverage until their blood sugar is over 150-200.

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I have definitely seen sliding scales starting at 100... mainly in acute care/med-surg floor settings. Their really big on tight glycemic control although there has been new research based evidence suggesting this is not always beneficial.

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Specializes in OB, Peds, Med Surg and Geriatric Nsg.

Most of my old residents sliding scale begins at 150-200. The young ones (in their 40's-50's) has a sliding scale of 99-149. Though I haven't given a Metformin at HS. Most Metformins are given in the AM or at 1700. I agree to all that gave their opinions to call the doctor and get a clarification.

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I would be making sure this person is getting a snack at night too.

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