Since becoming a nurse, I keep seeing insulin orders but with no parameters.
I've had a lady who's BG was 65 but the order was to give a fast acting insulin I held and went over with the charge nurse she said I shouldn't have ( i notified the Dr he too said to hold it)
Now I'm at a drug rehab (only nurse here)
A client had an appt today so he missed his noon time insulin he said the nurse gave it to him at 3:00 pm, he said he hadn't eaten because his teeth were pulled. I come in at 3:30 pm.
His glucose was 110 at 5:oo pm. H e said he didn't want to take it because he wasn't hungry yet. At 110 would you still give novolog? should I wait after he eats and recheck? any advice before I call on call?
I gave him that choice, I told him he had to be eating taking the insulin that's when he told me he didn't want to because he wasn't going to eat at the moment hen he came right back less than 10 mins.
What I was trying to elaborate on is if BS ranges from
There's no reason to correct a BG of 110 if that's what your asking. Insulin is given for 3 main reasons; to provide for basal insulin needs, to provide for nutritional insulin needs, and to correct for elevated BG levels, so it's important to know what the purpose is of the insulin you are considering holding.
There's no reason to correct a BG of 110 if that's what your asking. Insulin is given for 3 main reasons; to provide for basal insulin needs, to provide for nutritional insulin needs, and to correct for elevated BG levels, so it's important to know what the purpose is of the insulin you are considering holding.
Even when it's superbtime and they're getting ready to eat you would've still held it?
Even when it's superbtime and they're getting ready to eat you would've still held it?
So long as you're talking about the 5 unit nutritional dose you mentioned earlier then I would still give it with meals since it seems to be working for them if the pre-meal BG is 110. Keep in mind that if the nutritional dose is well matched to their post-meal BG increases then their BG shouldn't really change much. If their BG has been running the 40's an hour or two after meals then the dose doesn't appear appropriate and I would hold it and discuss a change of plans with the MD.
So long as you're talking about the 5 unit nutritional dose you mentioned earlier then I would still give it with meals since it seems to be working for them if the pre-meal BG is 110. Keep in mind that if the nutritional dose is well matched to their post-meal BG increases then their BG shouldn't really change much. If their BG has been running the 40's an hour or two after meals then the dose doesn't appear appropriate and I would hold it and discuss a change of plans with the MD.
Finally, I would just like to share my concern that you are at work and depending on this forum to make clinical decisions. That is not appropriate in my opinion. If you are not working in an environment with appropriate supports for you and your level of experience, perhaps you should begin to look elsewhere. And you should never hesitate to call the on-call physician to clarify orders over the cost of the consult.
Ditto.
Call the physician/provider responsible for the patient with these questions. That is your actual, real-time duty to the patient.
These types of discussions can still be had for educational purposes. Not for decision-making.
Specializes in Psych, Addictions, SOL (Student of Life).
Since becoming a nurse, I keep seeing insulin orders but with no parameters.
I've had a lady who's BG was 65 but the order was to give a fast acting insulin I held and went over with the charge nurse she said I shouldn't have ( i notified the Dr he too said to hold it)
Now I'm at a drug rehab (only nurse here)
A client had an appt today so he missed his noon time insulin he said the nurse gave it to him at 3:00 pm, he said he hadn't eaten because his teeth were pulled. I come in at 3:30 pm.
His glucose was 110 at 5:oo pm. H e said he didn't want to take it because he wasn't hungry yet. At 110 would you still give novolog? should I wait after he eats and recheck? any advice before I call on call?
Every facility I have worked at has a written protocol on when and how to treat low blood sugar and when to hold insulin. For example in my facility if a patient's blood sugar is 70 or above we give insulin per the sliding scale so in this case it would be No Coverage. If the patient is on longer acting such as Lantus it would be given as Lantus has no Immediate effect on blood sugar. This only changes if the Blood is 60 or below and the patient is symptomatic. Then we treat appropriately; snack , orange juice if able to swallow. If Blood sugar is 50 or below and able to swallow we feed them and recheck in 15 minutes. If not able to swallow or unresponsive/ confused we can give Glucagon and call physician prepare and call 911 if necessary.
That is just a snap shot of my facilities protocol. I used to come in the am to Blood Sugars over 300 and when I asked I was told "Well fasting was 80 so we gave him orange juice!" Completely outside protocol.
Specializes in LTC, assisted living, med-surg, psych.
There should be parameters with all insulin orders. If there are none, be proactive and call the provider for them. There's no reason for a nurse to guess at what to do when things go sideways.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Finally, I would just like to share my concern that you are at work and depending on this forum to make clinical decisions. That is not appropriate in my opinion. If you are not working in an environment with appropriate supports for you and your level of experience, perhaps you should begin to look elsewhere. And you should never hesitate to call the on-call physician to clarify orders over the cost of the consult.
Im so glad you wrote this; this is beyond concerning. It is one thing to seek other people's opinions after something has happened, but you appear to be seeking information to make real-time clinical decisions from strangers on the internet and there is absolutely nothing okay about that.
Call the physician/provider responsible for the patient with these questions. That is your actual, real-time duty to the patient.
These types of discussions can still be had for educational purposes. Not for decision-making.
The real-time advice seeking struck me that way as well at first, but if these discussions for "educational purposes" aren't so that the education we're referring to will result in affecting decision making, then I'm not sure what we think people are doing with the information shared in these discussions.
Whether a person uses what they've gleaned in one of these discussions to inform a decision they're making today or next week doesn't really seem to be a meaningful difference, it just makes those of use offering advice more aware of how that advice might translate to the decisions someone makes in their practice.
Specializes in orthopedic/trauma, Informatics, diabetes.
Insulin should not be held without and order. If you think the BG is too low, call and get instructions/orders from MD. If a person has mealtime insulin ordered, whether they are T1 or T2, they get insulin. If for some reason, they are low (
The real-time advice seeking struck me that way as well at first, but if these discussions for "educational purposes" aren't so that the education we're referring to will result in affecting decision making, then I'm not sure what we think people are doing with the information shared in these discussions.
Whether a person uses what they've gleaned in one of these discussions to inform a decision they're making today or next week doesn't really seem to be a meaningful difference, it just makes those of use offering advice more aware of how that advice might translate to the decisions someone makes in their practice.
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.
MunoRN, RN
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