Let me start off by saying that I am a new graduate nurse in an ED fellowship program, I am about mid way through the fellowship and am currently on a telemetry floor. I am in no way an overconfident new grad, however, I do believe I am a new grad with a higher caliber of knowledge and experience than many new grads who start entering the field (many years of ED Tech experience).
So 2 nights ago I had this DM II patient on accuchecks AC/HS, with orders for 20 U levemir + Humalog coverage at bedtime. He had a snack at bedtime and his sugar went down to 50 in the middle of the night, I took care of it, documented the event, no big deal. The next night I had the same exact set of patients, including this pt in particular. At bedtime his BS was 366. I called the house NP for advice and explained what had happened the night prior. She told me to hold his coverage and just give him the levemir. I thought that seemed like a good idea. I held the coverage, and only gave 20 U levemir, this time w.o a snack at bedtime because it had slipped my mind and I think his sugar being 366 made me think it wasn't anything to worry about...My PCA calls me to the room at 5 AM and says something isnt right. PT is diaphoretic, pale, lethargic, incomprehensible speech. Right away i know its hypoglyc. I grab the crash cart and his reading comes back
The house NP arrived and was in shock and awe stating how that its literally impossible for his sugar to drop that low from levemir alone and was concerned that maybe the pt was on metformin or something similar that could have built up in his body over time...none of those drugs are in his history or MAR.
Being that I am a new grad, This is obviously unsettling for me, I am well aware that I did not provide a snack before bedtime and I am open to criticism and worrisome that this was all my fault. I know about the symogyi effect and am well aware that people do drop at the middle of night...however I have never seen someone drop that low before b.c of that especially with a bedtime BS of 366. Please help. Thank you.
