To hold or not??

On 8/17/2021 at 3:53 PM, Cclm said:

This for the life of me stumps me everytime. 

If a patient is below blood sugar values, I know you hold short acting insulin but you do not hold long acting insulin correct? 

A general rule that I go by is if the person is alert and oriented and b/s is above 100, I will give it. But it's one of those situations  I would call the doc and ask for parameters, especially if the dose is in the 45u range. 

On 8/17/2021 at 4:53 PM, Cclm said:

This for the life of me stumps me everytime. 

If a patient is below blood sugar values, I know you hold short acting insulin but you do not hold long acting insulin correct? 

 

 

Just ask so we can look at previous readings. If it’s a fasting am low we will likely reduce nasal insulin. Would be reasonable to hold the rai 

Every doctor I have ever questioned on this says give the long acting insulin as this has a 24 hour effect which you'll have negated for the following day risking higher sugars if you omit it.

That said, my husband is diabetic and will reduce his long acting at night if he's low. He seems to to know what works for him and I think that's the key - ask the patient or their closest family what they normally do, what works for them and hopefully you'll get an understanding doctor who'll prescribe accordingly. I think with diabetes one size doesn't fit all.

This can definitely be a tough one. One place I worked the endocrinologist would get very upset for a hold for low sugars. He even specifically said he would give long acting down to 70 BG. ?

That being said, my personal rule/feel out has been smaller dose (like 10 units to maybe 15 units) has been to give if BG is 100 or greater. These instances are often "ask the patient their usual, etc.” as well. Knowing someone runs low at night can easily change my answer.  I always educate on symptoms of hypoglycemia with these patients specifically. 
Any higher dose I would call provider. It helps if you can see trends as well. 

I always give the long acting and only hold the short acting. If you're really worried about their blood sugar in the moment give them some juice. Holding Lantus makes the problems of chronic diabetes worse, and these are no less deadly then hypoglycemia.