Question on Pediatric Insulin Administration

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Hi, I work on an inpatient pediatric endocrinology floor. Currently, for my senior BSN project, I am working to set up a protocol for having sliding scales and/or carb counting for the nurses to be allowed to use when are known diabetics are in the hospital. Currently, we have to page the doctor with each and every blood sugar, and then get an insulin order. This requires alot of waiting and frustration on the part of the families that we hope to eliminate. I was wondering what those of you that work with peds patients currently do for inpatient orders. I'm especially interested if any facilities use standing orders.

Thanks alot for your help!!

Specializes in Psych, Pediatrics, GI, Diabetes.

Yeah, standing orders for insulin just isn't going to happen - I mean, 1 unit for one person can drop a blood sugar 30 points, but for another, 1 unit can drop someone 120 points - so, standing orders for insulin would be extremely dangerous in that sense...been working with diabetes for a while, I've seen everything from correction factors of 1:20 points to 1:150 points...and carb ratios from 1:5 carbs to 1:50 carbs...makes it difficult to have an overhead standing order to cover everybody...

Now, if the endo has set something up customized to EACH patient, that would be more feasible, but to everybody...I think it would be asking for disaster...

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Specializes in Pediatric/Adolescent, Med-Surg.
Yeah, standing orders for insulin just isn't going to happen - I mean, 1 unit for one person can drop a blood sugar 30 points, but for another, 1 unit can drop someone 120 points - so, standing orders for insulin would be extremely dangerous in that sense...been working with diabetes for a while, I've seen everything from correction factors of 1:20 points to 1:150 points...and carb ratios from 1:5 carbs to 1:50 carbs...makes it difficult to have an overhead standing order to cover everybody...

Now, if the endo has set something up customized to EACH patient, that would be more feasible, but to everybody...I think it would be asking for disaster...

Sorry, let me re-explain. All I'm asking is for those that are known diabetics with a home protocol to be allowed to have that exact same protocol as a standing order for their hospital stay. It might say "follow pt's home sliding scale of.... and follow pt's carb to insulin ratio of....." I know this is a very differnt idea for peds, But Seattle Children's currently does it, as well as Sutter Medical Center in Sacremento. From the detailed examples I've seen for both hospitals, these order sets are a little more involved than a simple one time order would be, but I believe that if the patient is getting their insulin much closer to when their blood sugar was originally checked it will lead to much better coverage.

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