To give or not give insulin

[Twisted Nurse]

I have had several patients who are on Novolog sliding scale at the hospital. Sometimes they have to get certain procedures done like angiograms or stress test or colonoscopy that require them to be NPO overnight. When I check their blood surgars, sometimes their blood sugars are around 170s. Other times it can be above 200s.

I've had several nurses say they don't give the insulin despite the number b/c the pts are NPO. Other nurses say they give the insulin depending on how high the blood sugar is. What are your guys thoughts or advice?

[suanna]

Really?- that is why you have a sliding scale for- to adjust the insulin dose based on the patients glucose when changes in condition and diet result in unpredictable blood sugar readings. If the patients glucose is elevated- it needs corrected. This is esp. true if they are having an invasive proceedure. Novalog is fast onset and short acting. You may want to get orders to adjust thier PO meds or scheduled long acting insulin, but I woud follow the SS unless the patient has repeated hypoglycemic episodes.- Then I would call for a new SS and follow that one.

[Esme12, ASN, BSN, RN]

Your physician orders should cover this. If not call them. many MD's do not want coverage unless >250

[Twisted Nurse]

Your physician orders should cover this. If not call them. many MD's do not want coverage unless >250

That's the problem....there are no MD orders. That's why I'm getting conflicting statements from nurses.

[Rose_Queen, BSN, MSN, RN]

Call to clarify. Chances are, if they're having a procedure the stress response is going to cause blood glucose to go even higher. I've taken care of cardiac patients who come down for surgery with a blood sugar of 200ish with no insulin given. Once we start surgery, that sugar can spike up to 400 or even higher, necessitating us to start an insulin drip. Definitely get guidance from the physician doing the procedure if orders aren't provided. Risks of infection increase with high blood sugars along with other possible complications. Much easier to reduce the risk than deal with the complication later.

[Pangea Reunited, ASN, RN]

I look at the patient's history to help me decide. If they have lows, especially after waking up in the morning, I might hold their sliding scale insulin. If they are always super-high, they're getting the insulin.

[RainMom]

We typically have orders to hold insulin if NPO. If not, I take into account the degree of elevation in glucose, their history & how soon they will be able to eat again. Usually I won't give insulin for glucose under 200 while NPO.

[scifispam]

I don't treat for less than 200 if npo

[MunoRN, RN]

There are very different types and reasons to give insulin, the insulin dependence of the patient must also be considered, in some patients it might be wise to hold a dose, in others it might be pretty reckless.

Insulin is given as a basal dose, a nutritional dose, and as a correctional dose. In an NPO patient it's really only the nutritional dose that should be held as a general rule. The basal dose may need to be held or may just need to be adjusted; a type I diabetic will still need some or even all their basal insulin even when NPO, and should generally have some other route of glucose (IV D5) to avoid ketosis. There's really no good reason to hold a correctional dose as it's not dependent on the patient eating.

[iluvgusgus]

If a pt were getting lantus and novolog and they had been NPO since midnight with a BS of 170, I wouldve held the novolog because SS usually starts at 150 and I wouldve given lantus because it does not have a peak. Novolog is short acting and is meant to accomodate their current BS and what they may add to it with what they are about to eat. If they are on a carb consistent diet and are adherent, I think they expect BS to raise 50 points with meals. If the pt has a poor appetite or is nauseous and may not eat, I would also consider holding their insulin depending on what their BS is. Sometimes the order may state "hold if NPO or poor PO intake". Sometimes SSI has a carb count with it so you would give it after you have seen what they have eaten for stricter BS control. I have never sent pts to cardiac surgery so that may be a different story and I would ask the dr, but for colonoscopies I think they will be fine. I would look at their other documented blood sugars and see if they are all over the place, because then I would definitely hold it, if it hangs around the same number and is almost 300 then I would give it. And in response to Suanna's post, I would use a little bit more critical thinking and nurse judgement rather than fall into the mentality of "duh, it's a dr order, follow it". Ive never seen much variation in sliding scales, they tend to adjust lantus doses if the pt is having hypoglycemic issues, not the novolog.

[pugmom79]

Are your npo diabetic pt it on some sort of d5 fluids? I would give the ss and lantus if they are on d5 fluids. It's a part if our protocol.

[Rags2Riches RN]

Where I've worked the insulin orders came with a protocol to hold insulin if NPO or change in status. If I were unsure though I would consult with the provider.