To blood sugar or not to blood sugar. That is the question.

[lkoch002]

If a patient is on a tube feeding and has no history of diabetes, do you automatically take blood sugars based on the sole fact they are getting a tube feeding? My thought is "no. You're using the gut, so it's kind of like me eating something. ..I don't take my blood sugars because I'm not diabetic. If it were TPN, I would say you do take blood sugars, so that you can manage it, as TPN is typically higher in sugar content". That's my rationale. ..so I'd like to hear what everyone else thinks about the topic.

A nursing care partner got really upset with me because I told her the patient was not on blood sugar checks and that i had not taken any. There was no doctors order. He had no history of DM...her reasoning being that he had a tube feeding. He did have altered mental status, but upon admission, his blood sugar was fine. His ammonia was high, which lactulose did it's job...mental status improved.

[morte, LPN, LVN]

20 + years ago in a CEU class, I was taught that anything over 150 potentially compromised the electrical conduction in the heart...

[kool-aide, RN]

I would tend to agree, however if this is an icu pt, potentially vented or septic, they maybe have hyperglycemia d/t those issues.

[MunoRN, RN]

Fresh hearts are stricter; they're started on an insulin drip to keep between 80-120 (I think...I haven't had one in forever so don't quote me on that. My hospital doesn't do that many hearts).

There are likely facilities out there still using the old goal ranges which were typically 80-110 or 120. The recommendations were changed relatively recently (2013), but the current society of thoracic surgeons recommendation is for

[**LaurelRN, MSN]

So here's the thing... I have done numerous papers and alot of research about this topic (not tube feeding specifically- but it ties in). If a patient is in the ICU, there is already a reason to do FSBS- sepsis, MI, neuro issues, cancer, infection- whatever. The inflammatory response is the same no matter the diagnosis. Now add into the stress and release of cortisol and on top of that add tube feedings, yep- you bet I'd be doing FSBS. Advocate for the patient. Euglycemia has been proven in numerous studies to decrease morbidity and mortality related to ICU admissions.

[MunoRN, RN]

So here's the thing... I have done numerous papers and alot of research about this topic (not tube feeding specifically- but it ties in). If a patient is in the ICU, there is already a reason to do FSBS- sepsis, MI, neuro issues, cancer, infection- whatever. The inflammatory response is the same no matter the diagnosis. Now add into the stress and release of cortisol and on top of that add tube feedings, yep- you bet I'd be doing FSBS. Advocate for the patient. Euglycemia has been proven in numerous studies to decrease morbidity and mortality related to ICU admissions.

Generally "euglycemia" refers to the defined range for "normal" BG which currently is 60-100. About 10 years ago there was a single, small study with questionable methods that appeared to suggest "tight" control was better in hospitalized patients, which led to recommendations for keeping critically ill patients between 80-110. Subsequent studies (which were much larger and better designed) failed to reproduce these results and actually found the opposite to be true, one of the studies actually had to be cancelled prior to completion because far too many patients in the 80-100 group were dying.

Currently there are no longer any recommendations for "tight" control. The American Diabetes Association has joined with the American Association of Clinical Endocrinologists to put out a consensus statement that appears to be the most widely referenced, it recommends a goal range in all patient populations, including critical care of 140-180 with a preference towards the lower end of that range. They also recommend that no range should go below 110. The American College of Physicians recommends a goal range of 140-200 for all hospitalized patients.

[vintagemother, BSN, CNA, LVN, RN]

Re post #17: our medical director told me the same thing! There is new research to support wider pentameter s!

[kddannemiller]

I worked in an ICU as an NA for almost 2 years and we took accuchecks when patient went on tube feeding, and 6 hours after starting. If BG was less than 120, no further testing. Over 120, continue testing 2x q6. Under 150, DC blood sugars. Granted, our patients all had lines and had regular blood draws so there wasn't more reason to finger stick unless we needed more immediate results.

[ICUNurseG]

Yes. Our hospital has a protocol that when someone is started on TF we do accuchecks q6h x 24h. If they're normal, we stop them.

Remember, even if they're not diabetic they are probably at risk for hyperglycemia of critical illness. Most pts we start TF on are usually on a vent, etc. In my opinion, fingersticks are safe and easy; unnoticed and untreated hyperglycemia is not.

[/username, BSN, RN]

Achieving normalized blood sugars has been shown to improve patient outcomes, and it's one of the few things we can control immediately.

[MunoRN, RN]

Achieving normalized blood sugars has been shown to improve patient outcomes, and it's one of the few things we can control immediately.

Actually achieving "normal" blood sugars has been clearly associated with higher mortality (normal being about 80-110). Permissive mild hyperglycemia is actually what's associated with the best patient outcomes.

[/username, BSN, RN]

Absolutely. By normal I wasn't thinking normal normal . I was thinking the icu normal of less than 150-160. Sorry should have made that more clear.