To blood sugar or not to blood sugar. That is the question.

Specialties MICU

Published

If a patient is on a tube feeding and has no history of diabetes, do you automatically take blood sugars based on the sole fact they are getting a tube feeding? My thought is "no. You're using the gut, so it's kind of like me eating something. ..I don't take my blood sugars because I'm not diabetic. If it were TPN, I would say you do take blood sugars, so that you can manage it, as TPN is typically higher in sugar content". That's my rationale. ..so I'd like to hear what everyone else thinks about the topic.

A nursing care partner got really upset with me because I told her the patient was not on blood sugar checks and that i had not taken any. There was no doctors order. He had no history of DM...her reasoning being that he had a tube feeding. He did have altered mental status, but upon admission, his blood sugar was fine. His ammonia was high, which lactulose did it's job...mental status improved.

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Specializes in Emergency Nursing.

If mental status is appropriate and patient has no history of diabetes I wouldn't check them without a doctors order unless the patient told me they weren't feeling well (shaky, dizzy, lightheade, etc...) or if they had a mental status change. Other than that, if it's not in your policy and procedures manual it sounds like that coworker is just looking for something to complain about.

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

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Specializes in ICU.

Yep, we check them. Everyone on tube feedings with us usually gets put on the glycemic protocol. If the patient is not diabetic, this can cause a lot of unnecessary work. If a blood sugar is ever over 150, we do q6h checks from that point on. Any subsequent BG checks at 110 or less require us to check BG q2h until we are back over 110. I had a non-diabetic patient getting fingersticks q2h for days because her blood sugar was almost always between 100 and 110. It was straight up idiotic.

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Specializes in SICU, trauma, neuro.

Most of ours are on a protocol because of their risk of stress-induced hyperglycemia. NPO pts (whether not yet being fed, on tubefeeds, or TPN) are q 6 hrs. Pts eating are AC & HS. Sliding scale insulin is given for any BG >150.

Fresh hearts are stricter; they're started on an insulin drip to keep between 80-120 (I think...I haven't had one in forever so don't quote me on that. My hospital doesn't do that many hearts).

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Specializes in Hospital Education Coordinator.

I was not ever a diabetic until one day when I was. How will you know if there is a change in the patient's condition if you do not assess it?

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Yep, we check them. Everyone on tube feedings with us usually gets put on the glycemic protocol. If the patient is not diabetic, this can cause a lot of unnecessary work. If a blood sugar is ever over 150, we do q6h checks from that point on. Any subsequent BG checks at 110 or less require us to check BG q2h until we are back over 110. I had a non-diabetic patient getting fingersticks q2h for days because her blood sugar was almost always between 100 and 110. It was straight up idiotic.

As a nondiabetic, I would refuse such nonsense. I would also refuse if my family member were non-diabetic and couldn't answer for themselves.

ETA: I'm talking about floor patients here; ICU protocols for the critically ill are different.

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I was not ever a diabetic until one day when I was. How will you know if there is a change in the patient's condition if you do not assess it?

People do not become magically diabetic from tube feeds being started. Presumably there are BMPs/CMPs being drawn in the am that show glucose. That's enough to get a read on what's going on.

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Thanks for all the input! I really appreciate the insight! :)

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I was not ever a diabetic until one day when I was. How will you know if there is a change in the patient's condition if you do not assess it?

The patients condition was not suggestive of hypoglycemia. He had AMS, which began improving with lactulose. Even after getting dextrose and such, his mental status did not change from baseline. .it did not improve. It makes sense to immediately check blood sugar in an emergent situation knowing nothing about a person who is non responsive, and of course, his blood sugar was taken upon admission and was satisfactory. As mentioned above, he was getting Cbc and BMP every morning. I agree that status changes should be assessed. Knowing that glucose was within normal limits, ammonia was the next target, which proved to be the culprit. That being said, after the course of treatment was already determined, I wouldn't think that blood sugars are necessary based solely on the fact that a patient is getting back tube feeding.

Diabetes is diagnosed by back set of values. Correct me if I'm wrong, but triglycerides, A1C values, abdominal girth...DM2 doesn't just happen over night to warrant continuous monitoring. I'd come closer to thinking DM1 would be the one to just pop up, as it's usually acquired through genetics. ...symptoms start showing up, triggering an office visit, then tests are run for diagnosis.

I guess what I'm trying to say is that it's unnecessary to check blood sugars based only on the fact that a patient is being tube fed. If hyperglycemia is the concern, i say its better to have too much than too little. In class, we were told 140-180 is what ICU patients need because of the stress they're unser. Anyways, the issue was whether or not we take blood sugars...based only on the fact that a tube feeding was going. It's an issue that many at my hospital are facing. Some nurses qmd care partners think its necessary, while others do not. They just recently sent out an email saying blood sugars will not be taken without a doctors order. ..so i guess that clears that up. ;)

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Specializes in Pediatrics, Women’s Health.

It is our policy to automatically check blood sugar q6h for anyone on tube feeds or TPN. The symptoms of hyper/hypoglycemia are not obvious in intubated and sedated patients. If they are fine for a couple days, then they might be reduced to BID or possibly D/C'd but it seems like we very rarely have patients that don't need at least a couple of units here or there to keep sugars under 150. I have not personally looked into it, but I have been told that the majority of the research shows that keeping critically ill patients' glucose under 150 is beneficial. Anyone looked into this? Even our patients who are not on any feeding are q6h for their first 24 hours - if they're all under 150 they can be D/C'd.

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Specializes in SICU, trauma, neuro.
Diabetes is diagnosed by back set of values. Correct me if I'm wrong, but triglycerides, A1C values, abdominal girth...DM2 doesn't just happen over night to warrant continuous monitoring. I'd come closer to thinking DM1 would be the one to just pop up, as it's usually acquired through genetics. ...symptoms start showing up, triggering an office visit, then tests are run for diagnosis.

Stress-induced. It's not at all uncommon to see BGs >300 in our necrotizing fasciitis patients (which we get a lot of, because my hospital has a hyperbaric chamber.)

Obviously that doesn't apply to your pt's situation, but just putting out there that new onset hyperglycemia is not limited to the typical newly dx'ed DM 2 pt.

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Specializes in SICU, trauma, neuro.
I have not personally looked into it, but I have been told that the majority of the research shows that keeping critically ill patients' glucose under 150 is beneficial. Anyone looked into this?.

I haven't read the research either, but our ICU sliding scales all treat BGs >150.

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