Questions about morning blood sugars/insulin

[Logracia, ADN, RN]

Hi, I am trying to help improve the morning insulin administration on my floor and I would love to hear from nurses everywhere about how your facility manages morning blood sugar and insulin coverage. On my unit, our night shift does morning blood sugars and insulin administration between 630 and 7am, change of shift at 7, breakfast trays come out at 0730. Most of our AC/HS insulin is usually rapid acting insulin. I just have the following questions and any extra input/suggestions would be appreciated.

1. Which shift does blood sugars and insulin administration at your facility?

2. What time is morning insulin given?

3. What time do breakfast trays arrive?

4. If you are day shift and you do morning insulins, how does this affect your morning?

[canoehead, BSN, RN]

Day shift does glucose and insulin. Shift change is at 7a and trays arrive at 830ish. Myself, I don't arrive with insulin until the trays are at the bedside.

[mmc51264, BSN, MSN, RN]

I am the diabetes "champion" on my unit (and parent of 2 Type 1 kids).

BG does not get taken until trays arrive. Insulin needs to be given within 30 minutes of eating and the BG should be no more than 30 minutes old when administering insulin.

Our NPO pts get BG Q6H and are sliding scale only. Some patients, insulin needs to be given after they eat if they have poor appetites. Type 1s are a whole different beast and there is usually a plan set up with the pt and provider coming up with a plan as they have a different regimen than most T2s.

As far as who take the BG, whoever. Sometimes the aides take it, sometimes the nurses take it. It is more important when it is taken.

We have decreased med errors and hypo/hyperlgycemic events with these protocols. We use the acronym "T.I.E." Trays. Insulin. Eat.

[Pepper The Cat, BSN, RN]

I do not give insulin until the meal tray is in front of the patient. You never know what can happen. Kitchen can be short staffed so trays are late. Equipment malfunction can occur and trays are late.

Day shift does the glucose and gives the insulin.

[Logracia, ADN, RN]

Does anybody else have breakfast as early as 0730? Our aids are not allowed to do blood sugars (we are in California) so it has to be the nurse who does it. I've talked with other day shift nurses on my unit and their biggest concern is how early the breakfast trays come, which makes for quite a rush if they have to do finger sticks and insulin at 0730. Their fear is not having time to look at orders, labs, etc before the patient starts eating.

I'm thinking either breakfast needs to be pushed back or the diabetic trays need to be held until the nurse can check sugars.

[beekee]

Shift change between 7 and 7:30.

If the patient orders before shift change, night shift nursing assistants gets the blood glucose level. The period between 7 and 7:30 is a no man’s land, unfortunately. But, the night nursing assistant SHOULD be getting it.

If food arrives before or during shift change, the night shift nurse will administer the insulin.

Anything after 7:30 is on the day shift.

We try to keep the blood glucose checks within 30 minutes of eating, but realistically, that time period is incredibly busy so I usually settle for having a reading.

Nurses can do blood glucose checks too if needed.

[guest908299]

Day shift does glucose check and insulin on my unit. Additionally, our diabetic patients have trays labeled with a "Med Alert" label, meaning they are delivered to the nurse's station and not directly to the patients.

[Logracia, ADN, RN]

5 minutes ago, asystole4 said:

Day shift does glucose check and insulin on my unit. Additionally, our diabetic patients have trays labeled with a "Med Alert" label, meaning they are delivered to the nurse's station and not directly to the patients.

I really like that idea of putting a label on diabetic trays. Definitely something I think we should consider.

[guest908299]

1 minute ago, Logracia said:

I really like that idea of putting a label on diabetic trays. Definitely something I think we should consider.

I think it's really helpful, gives nurses a little time to check the blood sugar, give the tray, give insulin. Patients do sometimes get frustrated with the delay in getting their trays/food not being as hot.

[Loco-Bonita, BSN, RN]

On 8/13/2019 at 5:19 PM, mmc51264 said:

I am the diabetes "champion" on my unit (and parent of 2 Type 1 kids).

BG does not get taken until trays arrive. Insulin needs to be given within 30 minutes of eating and the BG should be no more than 30 minutes old when administering insulin.

Our NPO pts get BG Q6H and are sliding scale only. Some patients, insulin needs to be given after they eat if they have poor appetites. Type 1s are a whole different beast and there is usually a plan set up with the pt and provider coming up with a plan as they have a different regimen than most T2s.

As far as who take the BG, whoever. Sometimes the aides take it, sometimes the nurses take it. It is more important when it is taken.

We have decreased med errors and hypo/hyperlgycemic events with these protocols. We use the acronym "T.I.E." Trays. Insulin. Eat.

We also follow these guidelines, although we don’t use the T.I.E. acronym, we follow it in practice. During shift change, the CNAs are responsive for taking the CBG and day shift gives insulin. If a tray comes before report, the night nurse gives the insulin.

We also have orders in Epic that tell the dietary staff to check with the nurse before giving the tray, so they tray will sit at the nurses station for a few minutes, if needed, until someone takes it in to get a blood sugar.

[BSN-to-MSN, ADN, BSN, RN]

On 8/13/2019 at 6:44 PM, Logracia said:

Hi, I am trying to help improve the morning insulin administration on my floor and I would love to hear from nurses everywhere about how your facility manages morning blood sugar and insulin coverage. On my unit, our night shift does morning blood sugars and insulin administration between 630 and 7am, change of shift at 7, breakfast trays come out at 0730. Most of our AC/HS insulin is usually rapid acting insulin. I just have the following questions and any extra input/suggestions would be appreciated.

1. Which shift does blood sugars and insulin administration at your facility?

2. What time is morning insulin given?

3. What time do breakfast trays arrive?

4. If you are day shift and you do morning insulins, how does this affect your morning?

Blood glucose checked after patient orders breakfast. This varies as patients call downstairs individually, no specific time. If npo, by checked q6hrs..

Morning insulin given during breakfast.

Any time after patient orders tray, or we order for them.

It affects my morning just as if any med pass. Night charge tries not to assign many accuchecks to the same nurse. Although, one time I had 4/4 accuchecks/insulin patients. That was busy work.

Recently, they implemented 2AM bg checks, to screen for hypoglycemia during sleep. Patients are not happy with this.

[hawaiicarl, BSN, RN]

We used to have night shift check sugar and give insulin, until we had a couple hypoglycemic events due to delayed trays, or a Dr. all of a sudden deciding pt needs to be NPO etc etc. We actually changed our policy similar to the TIE acronym, which I like a lot (the acronym). It also helps promote "rest at night" which is related to one of the HCAPS scoring questions.

Cheers