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?
My facilities really struggle with this. Patient’s can order whenever they want. Which means someone might be eating breakfast at 0700 and another at 0930. And they might have 20 carbs on that tray or 65. Same with lunch/dinner so it gets way too hard to try and coordinate that because patient’s *always* forget to let us know when they order. Usually dietary will ask if they have been checked before delivering the tray but not always. And then you don’t always have time to run and check them.
Usually everyone is checked with vitals in the morning. And then we roughly try and do lunch and dinner when they order. But it depends on the PCT. So, yes, we are correcting off of BG that can be 1-2 hrs later if bundled with meal dose. But honestly I don’t know anyone who has had a hypoglycemic event from that even if not best practice.
A lot of our doctors have just started doing basal + correction and not doing a meal dose. That is so much easier. If they keep running high than they put in a meal dose.
We did stop correcting at 0300 though and just do testing. Pharmacy found it was interfering with the decisions on how to change lantus and also sometimes too close to morning dose.
As a nurse and a Type 1 myself for 49 years, I have a problem with facilities that stick to straight time schedules. Taking blood sugars AND giving insulin at 0700 and then not getting food until 30 minutes later, can be a huge problem. I would like to see a day when hospitalized diabetics (who are capable of doing so) are responsible for our own blood sugar testing and insulin administration. I realize some hospitalizations require that these are closely monitored and patients may be too sick to manage their own. But we have a disease that we are left to manage when we aren't in the hospital, but once we hit the doors, suddenly all that independence is taken from us, and our daily diabetes routine is on the hospital schedule and not ours. Everyone's body reacts differently to insulin and food, and most diabetics I know, know their bodies well enough to give insulin when it works for them. Myself I find that Humalog seems to take longer to work, like 30-45 minutes from administration. There are so many variables to diabetes that regimenting meals and insulin on a strict clock that what works for one diabetic will not work for another. Same goes for low blood sugar. Fifteen carbs has never been enough to combat hypoglycemia for me, but it does others. As more and more diabetics get insulin pumps, or continuous glocuse monitors, we hopefully will see a shift to the patient continuing to control their disease on their own while hospitalized, under watchful eye of the doctor. As stated earlier, the "test, insulin, eat" would be the best choice with insulin NOT being administrated until the patient has the tray in front of them.
Elaken
58 Posts
My facilities really struggle with this. Patient’s can order whenever they want. Which means someone might be eating breakfast at 0700 and another at 0930. And they might have 20 carbs on that tray or 65. Same with lunch/dinner so it gets way too hard to try and coordinate that because patient’s *always* forget to let us know when they order. Usually dietary will ask if they have been checked before delivering the tray but not always. And then you don’t always have time to run and check them.
Usually everyone is checked with vitals in the morning. And then we roughly try and do lunch and dinner when they order. But it depends on the PCT. So, yes, we are correcting off of BG that can be 1-2 hrs later if bundled with meal dose. But honestly I don’t know anyone who has had a hypoglycemic event from that even if not best practice.
A lot of our doctors have just started doing basal + correction and not doing a meal dose. That is so much easier. If they keep running high than they put in a meal dose.
We did stop correcting at 0300 though and just do testing. Pharmacy found it was interfering with the decisions on how to change lantus and also sometimes too close to morning dose.