dansingrn

Lantus is a basal insulin. Basal insulin is NOT adjusted for PO intake, rather, the rapid acting insulins are adjusted based on the carbohydrate content of the meal or snack. Lantus is adjusted based on a pattern of morning glucose readings. If the pattern is low morning BGs, then the bedtime Lantus may be lowered, usually by about 10% (3.5 units in this case). A morning BG of 87 is excellent. The range of human BG is the same for everyone. We don't think in terms of "low" for a particular person. If a person is symptomatic of hypoglycemia at 90, which is actually an in-range BG, then that usually means they have been running overall high BGs recently. To "re-set" their autonomic response that brings on symptoms of hypoglycemia, they need to have their average BGs in range for a period of time. This can be done by gradually lowering the BGs over time (ie gradually increasing insulin) so that they aren't so symptomatic. Running the BGs consistently too high to avoid a feeling of hypoglycemia is not proper BG management and ultimately leads to all the sequelae of hyperglycemia.

I'm thinking if the child requires overnight home health and TPN/lipids, he may not be in a situation where he can be responsible for his T1DM care...

Glucose levels that high are definitely not dawn phenomenon. The child needs more insulin overall; I would contact the physician for sure. You mentioned that he gets Novolog per the bolus wizard, he should also be getting a basal infusion. Those rates need to be adjusted, and only the physician or NP can do that. It is usually fairly easy to control BGs when on TPN and lipids, as the carbohydrate content is constant. There are many things to consider, most important is whether the child is developing ketones during his hyperglycemia. There is a meter than can test for this in the blood much sooner that can be detected in the urine. Additionally, the pump tubing and subcu catheter must always be checked for occlusion - the reason you don't treat extreme hyperglycemia through the pump.

I am a pediatric nurse practitioner working in an Integrative Pain Management department at a children's hospital. We do use Western medicine, but also incorporate massage, aromatherapy, diet, stress management, self-hypnosis, relaxation/meditation techniques, yoga therapy and acupuncture. It never ceases to amaze me how these complementary modalities seem to make all the difference, and how effective they are for chronic pain management. A BONUS - the benefits affect many aspects of our patients lives, not just chronic pain :)

I went to a (mostly) online NP program. It required a GRE and a master's thesis before a panel of tenured faculty. The program was through a state university, and the professors were from the university's school of nursing, all PhD nurses. I don't understand why the OP assumes that online equates to simulated patients and "easy" courses. OF COURSE we learned pelvic exams/PAPs on real humans, the very same "professional patients" the med students learn with. OF COURSE we must complete as many clinical hours doing actual patient care with qualified preceptors that the B&M institutions require. An ENORMOUS benefit of online NP schools is that there are many more clinical opportunities when arranged for individual students. My university is in a smaller city with far fewer hospitals, clinics and especially pediatric opportunities (I'm a PNP) than the larger cities can offer. If every NP student left their lives (families, jobs, etc) to move to this small college town for 2-3 years, there simply would not be enough quality clinical experiences to go around for the students. At the graduate level, and as an experienced nurse, I took responsibility for my own learning with regard to the content. There were many creative ways to experience lectures that did not require sitting in a classroom (I won't mention them all here, those of us familiar with current technology are already familiar). I must add that online courses that have rather stringent criteria for frequency and quality of postings (student interactions) can be extremely challenging and time consuming. I started my NP program at a B & M, and was put off by the poor teaching, poor student support, and students sitting in the back, unprepared and nonparticipatory. I transferred to an online program that was far more rigorous. In order to get a grade in an online program, there are standards for participating online, including references for post every post. Not AT ALL saying that online is "better" than B&M, just feeling a bit defensive at the assumption I hear all the time that online programs at the graduate level are inferior and "easy."

It's fine to prefill syringes with NPH, home health nurses have been prefilling for their patients who are blind or have dexterity problems for eons. It's important to remember with NPH that the suspension must be mixed as evenly as possible before filling syringes or the concentration will not be uniform. NEVER shake NPH vials, but roll between the palms, then tip upside down/right side up several times until fully suspended. When using the pre-filled syringes, warm by rolling between your palms or let come to room temp, then tip the syringe several times to let the precipitate suspend again. This will prevent clogging of the needle, and ensure that all the suspension is delivered and none is left in the syringe.

This is a question that even the insulin manufacturers struggle with. There are several factors, such as number of injections per day (number of times the rubber stopper is penetrated), temperature, sterility, etc. that can affect (however slightly) the potency of opened insulin. The most practical answer we give our pediatric patients is to use opened insulin pens or vials within 30 days, or monthly. This allows a new pen to be taken to school on the same day of the month each month. There is no practical difference in potency between the 28th and 30th (or 31st) day. Hope this helps. Here is a link with more details: http://care.diabetesjournals.org/content/26/9/2665.full

Omitting insulin causes the body to use fat rather than glucose for an energy source. Fat metabolism creates ketones (acids in the blood). Ketones cause nausea and vomiting, so that be one cause of nausea with missed insulin doses. Rapidly changing glucose levels can "feel like" highs or lows, regardless of the actual glucose level. If you took rapid acting insulin after missing the Lantus, the drop in glucose can feel like a low, even if you are still hyperglycemic, like if you drop from 500 to 300.

blood glucose 2,217

Finished my NP at 49. And I was not the "oldest kid in the class" by a longshot!!! Do it!

Standard sick day management is to treat the hyperglycemia, adding even more insulin if ketones are present (even if NPO, even if vomiting!). Definitely needs insulin in presence of infection, so clarification with the provider is indicated here.

np2b - Do you have peds RN experience? PM me . . . I have a lead on a PNP position in your general region if you are willing to consider a subspecialty in a children's hospital.

I'm an NP in chronic disease management. I work in peds with type 1 diabetes. (The answer is NOT ALWAYS fnp!!) The time to work on preventing complications is at diagnosis. Therefore, working in peds (as a peds specialist, not the broader fnp) hopefully addresses these very issues. Proud to be a PNP

Try University of Missouri (Columbia) Sinclair School of Nursing.

Absolutely this tech cannot be required by an employer to revert to injections! Contact the American Diabetes Association for details regarding discrimination against persons with diabetes.