Question about giving insulin to non-critical, non-diabetic patients.

[rnorby]

Hi. I am a CNA and currently working on my prerequisites for nursing school. This is my first post on Allnurses. My question concerns some treatment given recently to an elderly family member with early/middle stage dementia, who was being treated for pneumonia.

We are still in the process of obtaining all of his relevant medical records, but according to what we have, it seems that he was assigned to an Apidra sliding scale insulin protocol on the basis of his having presented with a blood glucose level of 120 mg/dl.

We believe that he was not actually given any insulin until the following evening, since that was the firsr time that he felt well enough to eat most of his meal. According to the nurse who was on duty that evening, he was given 3 units of Apidra insulin aproximately 40 minutes after finishing his meal.

My question is whether anyone here has heard of this sort of insulin protocol being instituted for patients presenting with only marginally elevated blood glucoses? (this was not a fasting glucose either). I have not been able to find any evidence for the practice in any of the medical literature that I have searched through. Everything that I have read has suggested that something of this nature could be very dangerous due to the risk of hypoglycemia.

We believe that he did in fact suffer from an episode of hypoglycemia, as he underwent a rapid and extremely dramatic decline in mental status not long after the insulin was administered. This decline in mental status was attributed by the staff and doctor to "sundowning" for which the patient was subsequently severely overmedicated, first with morphine in order to insert a Foley (he had suddenly become incontinent), and then with Zyprexa to treat the increase in agitation that followed the morphine. The effects of the overmedication ended up extending his hospital stay by 4 extra days as he was essentially in a stupor from the Zyprexa for several days. The original intent had been to release him the following day.

I am really curious to know if this kind of liberal use of insulin in non-diabetics is common in hospitals, and if so, how is the risk of hypoglycemia usually managed.

Thank you.

[llg, PhD, RN]

You seem to be searching for evidence for a law suit or something. That's the kind of thing we don't want to get involved with here.

[rnorby]

I apologize for the tone. There's not going to be a lawsuit. I don't think there would even be a basis for one, since there was no permanent damage.

I was just really surprised that a patient would be given insulin under these circumstances and was curious as to whether this is a frequent practice or not.

Again, I apologize for my tone, and understand if you don't want to answer.

[llg, PhD, RN]

If you are not thinking there was a problem with the care, why are you trying to get all of his records?

... and without knowing the whole story, it would be inappropriate for anyone to HAVE much of an opinion, much less comment on it on the internet.

I wish you and your family all the best of luck, health, and long life.

[rnorby]

Oh, I definitely think there was a problem with his care. His attending physician didn't even know he had been given insulin until he was informed of such by the other family member.

I am, however, genuinely intetrested in what the usual protocols are for treating hyperglycemia in non-diabetics, and whether anyone else has seen a bg of 120 serve as a threshold for initiating insulin therapy.

My question (or the way it was asked) was obviously inappropriate, and I feel pretty chastened. I will have to look for other ways of getting the information, as I have become quite curious about this issue. Not on this forum though, it looks like.

I apologize again for my inappropriateness.

[llg, PhD, RN]

I'm sorry if I offended you or chase you away from allnurses forever. I didn't mean to. I was just trying to explain why it would be inappropriate for someone to comment on the quality of care of a particular patient.

I hope you decide to hang out here a while and "learn the ropes" of this site. You can learn a lot here and find lots of supportive friends. We just can't comment on the quality of care of an individual patient.