question regarding insulin administration

I would call the provider on call and have it addressed at next rounds....something sounds really wrong.

Give it according to the sliding scale...they've had dinner, their blood sugar is 220. They are in need of insulin otherwise it will continue to get higher through the night.

Jen

The facility I work at uses the sliding scale of FSBS minus 200 then divide by 20, don't give less than 4 units regular insulin. So I wouldn't give insulin and I would provide a diabetic hs snack.

I'm sorry but I don't follow the "They are in need of insulin otherwise it will continue to get higher through the night." What's the fuel source when they are sleeping? I do realize there is a specific diabetic population that have peculiar phenomena during sleep hours that influence blood sugars but in general it seems blood sugars decrease during sleep hours.

Please correct my line of thinking if I'm wrong. Just my 2 cents.

in the past, she always needed insulin coverage,and generally her blood sugar runs from 200 to sometimes 300. but today when i checked her blood sugar before dinner, it went down really low (less than 50) and i gave her a drink and her blood sugar went up to 220. she only gets regular insulin based on sliding scale, no nph or 70/30. when i check her blood sugar again around 9pm, her blood sugar was 220. so i gave her coverage with regular at hs and at midnight shift, her blood sugar dropped low again. next day, midnight nurse told me next time hold hs regular insulin and she told me she held morning regular insulin, and her blood sugar went up to 300 at lunchtime. is this correct?

i would call the m.d. and review the past glucose levels. this resident is not well controlled. maybe she needs an oral med like glucophage. i would also have the dietician review her diet. what is her glycohemoglobin level?

Give as ordered and call the MD to get a better coverage! If they go hyper or hypo glycemic you can assist PRN, or even call emergency/9-11 if their is a symptomatic reaction or you need assistance.

I don't mess around with insulins because that is an MD order to change! I contact MD's (even on calls) for situations like this! It also alerts the MD that the coverage isn't working anymore and they need a better routine of insulin (it happens! Someone could be sick or a UTI and change their blood glucose levels suddenly even before symptoms of the illness or UTI are seen, or even stress can cause this!).

If I think I may cause a reaction by giving insulin I will hold and call for MD support! But someone at 220 sliding scale with no symptoms I would have given the regular, but with that days decrease suddenly I would have backed it up by having plenty of juice on hand and monitored well :) (I have orders to check all diabetics glucose levels PRN at my descression!).

Good luck...I think you did just fine, it is not for nurses to mess with...up to the doc! (it may also be time to go from a General Practice MD to a Endocinologist if she doesn't have one to get that order more attuned to her needs!).