New Nurse, New Job...Insulin q's

Salisburysteak, BSN, RN · Jul 24, 2012

Is that normal? Not really because usually SSI will be given if a Blood sugar is over 200 or 250? What Insulin is this resident on? Is it fast acting like Novolin or is this resident on long acting like Lantus or Levimir? What is this resident's HgbA1C? If it is in the controlled range then it should not be a problem. Is the MD aware of these comsistently high blood sugars. If the MD isn't someone needs to let him know. Either this residents PO meds need to be adjusted or the insulin needs to be adjusted. How is this person appetite? Poor, fair, or good. How compliant with his diet? Are there any other health issues affecting his blood sugar like pancreas problems?

I would look through his chart and check his prior labs and blood sugars to see if this is a new problem or if this resident has aleays had blood sugars like that.

As a new nurse this will be great practice at using your critical thinking skills. Hope this helped. :)

KayDubb · Jul 24, 2012

Thanks for responding...I havent had time to review the chart...but I did look over 17 days worth of blood sugar readings..they were all around 280 on average. This facilty does not use the sliding scale method..He receives Novolog 70/30 twice a day before meals and prandin po once a day. I know he has kidney issues as he has a suprapubic catheter...I will def read the chart..I wondered why myself why maybe more insulin wasnt ordered...but again Im new and learning..

Salisburysteak, BSN, RN · Jul 24, 2012

It definitely sounds like he needs his insulin and PO meds evaluated. He sounds like a good candidate for Levimir or Lantus. I would look through the chart and then notify MD about this.

I did have a really old school MD tell me that it is better to run high than low. I cannot grasp that concept. I was taught that a A1c level within limits means Diabetes is controlled.

If the resident has high blood sugar look for signs of DKA. Where I used to work at we had a resident that had no hx of Diabetes and for about two days he was c/o nausea with vomiting and excessive thirst. He was also extremely irritable. We thought he was starting to stroke out. No fruity breath was noted. we did send him out. He spent three days in the ICU with IV insulin. His A1C was 18! Yes 18!!!

When I left there his blood sugars were still out of whack. It doesn't help he is non-compliant with his new diet!

SHGR, MSN, RN, CNS · Jul 24, 2012

With elderly people, hypoglycemia is riskier than with younger people. Also, in people with "limited life expectancy" you can naturally be less concerned about highs.

But within reason.

For this particular man, I would think a fasting blood sugar somewhere in the 120-140 range would be desirable, postprandial readings in the 160-190 range. Something like that. In people with kidney failure, the sugars may be more labile, so you need to be more vigilant to avoid a low. (under 80). What I have seen, in patients with mixed insulins, is that they seem to go low mid-day.

That said, a pattern of blood sugars around 280 should not be acceptable for anyone, especially on a consistent basis when there are nurses managing his care! I am so not a fan of sliding scales in general. If someone is always running on the high side, then the whole regimen needs to be looked at, not just a temporary fix.

Good for you for looking for patterns and noticing what is going on rather than accepting this as status quo. Best wishes to you and the residents you care for.