When do you hold insulin if no parameters?

Kareegasee · Sep 30, 2018

This is killing me. Why has there been so much discussion lately with new nurses and their emotional traumas over insulin? It's really not that complicated. If they are low, don't give the correction-dose or standing dose. Always give the carb coverage for a meal. Stop seeing the entire order as a complex formula and just use your common sense and nursing judgement: if you give insulin, their blood sugar will drop; if you don't, it will elevate. If you are in doubt, ask your charge nurse, supervisor, or doc.

MJLPN727 · Oct 1, 2018

Not sure if this will apply to your situation but maybe will be helpful for you to read. Where I worked on a long term care floor in a nursing home, as long as sugars were normal (70 and up) I gave scheduled insulin. I did this because some of our patients had orders for pre meal insulin (as opposed to sliding scale) that had been ordered by the provider who reviewed their sugars/history. Now if someones sugar was 70 at 4 pm and had 8 units scheduled before dinner, I typically would give them a snack and then wait until their food was physically in front of them to administer insulin.( of course this went for people who were eating in the privacy of their rooms- again a long term care floor.) If I had any concerns I'd reach out to the provider sooner than later and get the order to either administer or hold (AND DOCUMENT IT!) and again just be sure that they ate after. Sometimes it can give you "sticker shock" to see the units that are ordered for a patient before a meal, but some of your patients have insulin resistance and need those higher doses, and again thats the doctors call. So long story short: if sugars are normal give insulin. if sugars are borderline normal like below 100 give a snack and then make sure they eat their meal. Never hesitate to recheck sugar. If your patients are "with it" remember to educate them that if they "feel funny" ie clammy hungry dizzy etc that they need to let you know. Also, if they get hypoglycemic and are able to swallow my favoirte quick fix is orange juice with a packet of sugar in it. if your patients are wondering if the dose of insulin is appropriate maybe they need to talk to their provider about adjustments or about going on a sliding scale vs scheduled. However. when i started nursing and was nervous about insulin for the exact reasons youre posting about! I talked to my friend who is a doctor and she told me that research shows LTC residents having better control of their blood sugars with scheduled insulin vs sliding scale. Also, long acting insulin is less worrisome. Some people may have orders to hold the long acting under 100 etc, but long acting insulin wont drop you as drastically or as quick.

Good luck hope this makes you feel more comfortable. Sometimes I found it useful to think of the good that the medicines I give is doing, instead of feeling so nervous about adverse effects that it affects my ability to give medications confidently. Medicine can be good and help people very much so don't be afraid of it. Be responsible and educated but not afraid!

mzsuccess · Oct 1, 2018

would absolutely not give Novolog for a blood sugar of 110 if the pt wasn't eating. Hold, hold, hold.

He did eat, I actually waited until he warmed food and gave it. I held it because he said he wasn't ready but once he warmed his food I gave it and walked him over to his plate

mzsuccess · Oct 1, 2018

Not sure if this will apply to your situation but maybe will be helpful for you to read. Where I worked on a long term care floor in a nursing home, as long as sugars were normal (70 and up) I gave scheduled insulin. I did this because some of our patients had orders for pre meal insulin (as opposed to sliding scale) that had been ordered by the provider who reviewed their sugars/history. Now if someones sugar was 70 at 4 pm and had 8 units scheduled before dinner, I typically would give them a snack and then wait until their food was physically in front of them to administer insulin.( of course this went for people who were eating in the privacy of their rooms- again a long term care floor.) If I had any concerns I'd reach out to the provider sooner than later and get the order to either administer or hold (AND DOCUMENT IT!) and again just be sure that they ate after. Sometimes it can give you "sticker shock" to see the units that are ordered for a patient before a meal, but some of your patients have insulin resistance and need those higher doses, and again thats the doctors call. So long story short: if sugars are normal give insulin. if sugars are borderline normal like below 100 give a snack and then make sure they eat their meal. Never hesitate to recheck sugar. If your patients are "with it" remember to educate them that if they "feel funny" ie clammy hungry dizzy etc that they need to let you know. Also, if they get hypoglycemic and are able to swallow my favoirte quick fix is orange juice with a packet of sugar in it. if your patients are wondering if the dose of insulin is appropriate maybe they need to talk to their provider about adjustments or about going on a sliding scale vs scheduled. However. when i started nursing and was nervous about insulin for the exact reasons youre posting about! I talked to my friend who is a doctor and she told me that research shows LTC residents having better control of their blood sugars with scheduled insulin vs sliding scale. Also, long acting insulin is less worrisome. Some people may have orders to hold the long acting under 100 etc, but long acting insulin wont drop you as drastically or as quick.
Good luck hope this makes you feel more comfortable. Sometimes I found it useful to think of the good that the medicines I give is doing, instead of feeling so nervous about adverse effects that it affects my ability to give medications confidently. Medicine can be good and help people very much so don't be afraid of it. Be responsible and educated but not afraid!

This helped a ton! Thanks

mzsuccess · Oct 1, 2018

My thought was just that discussions like this are worthwhile for encouraging contemplation and personal research and for increasing holding knowledge or gaining a better basic/non-specific foundational understanding that can be leveraged in the future. Big concepts being made more clear.
And I continue to find it concerning the number of times that we lose track of the idea that we should be able to speak to a provider when patient situations arise. People feel completely up a creek if there's no protocol these days - which has never been the case and isn't now either.

I agree