One question about insulin.

  1. Hi all,

    It is a great forum to share experience with others.

    The following example is a pre-set scenario:

    A patient is on NovoMix BD, before breakfast 08:00 and before dinner 17:00.

    At 07:30, if BSL is 4.0 mmol/L, what would you do? would like to give NovoMix half hour before breakfast at 08:00?

    At 07:30, if BSL is 4.2 mmol/L, what would you do?

    At 07:30, if BSL is 4.6 mmol/L, what would you do?

    At 07:30, if BSL is 5.0 mmol/L, what would you do?

    Can anyone share your experience here?

    Thanks.
    Last edit by John 2018 on Jun 18
  2. Visit John 2018 profile page

    About John 2018

    Joined: Jun '18; Posts: 41; Likes: 4

    17 Comments

  3. by   Silverdragon102
    What would you do?
  4. by   John 2018
    Can anyone share your experience here?
  5. by   meanmaryjean
    Quote from John 2018
    Can anyone share your experience here?
    Seems like homework.and we always ask YOU to tell us what YOU think the answers are and then WE provide feedback. In other words, we don't do the homework for you.
  6. by   John 2018
    This question looks simple. However, it could be a little bit complex. My question established the opportunity for others to share experience.

    It is not a homework. I am a nurse.
  7. by   Silverdragon102
    Then you can give an idea on what you would do and members will chime in with their thoughts
  8. by   SimpleClaudia
    @JOHN2018.
    I wish you would give the dose of the Novomix BD. Deciding to give or withhold the Insulin due dose can be a dilemma sometimes because of several factors. 1.) Does your doctor sets the parameter when you need to notify the BGL readings? 2.) Chronic DM patients sometime will report signs of hypoglycemia even their BGL (5-7 mmol/l)which is considered within normal ranges for regular people however for DM patients we need to consider this before administering any insulin. 3.) Consider the dose, if the dose she is getting is over 20 units and her BGL is <5. I will withhold the dose and refer. 4.) Check their present status, are they eating well? Are they sick that affects their appetite. We need to consider other factors that affects the low BGL.
    The newly diagnosed clients commencing on insulin therapy, usually starts at low doses. So if her BGL is 4 or 4.2 I will still withhold her dose. If >4.6, I will administer her Novomix right before she will commence her meal and to stay on the safe side, I will do a post-prandial BGL and if it is low, its best to ask for a review of the dosage.
    Other nurses may respond differently. This is just my opinion.
  9. by   John 2018
    I believe you are a senior nurse with rich experience.

    The paragraph you wrote here is quite good, except two typos.

    One sentence from your paragraph, "if the dose she is getting is over 20 units and her BGL is <5. I will withhold the dose and refer."

    It wouldn't be "withhold". It can be "delay".

    Another sentence from your paragraph, "if her BGL is 4 or 4.2 I will still withhold her dose."

    It wouldn't be "withhold". It can be "delay".

    Thanks.
  10. by   SimpleClaudia
    @JOHN2018.
    Hi John, like I said, we all react to situations diffently. The clinical judgement we each take differs. I may say withhold, you may say delay.
    You raise a situation that requires clinical judgement. The main point is, what you do next? When I decide to withhold the dose. My judgement didnt ends there. I escalate it and go from there.
    When you decide to "delay" the dose. It can also mean, you let them have their breakfast and give the dose after meal. I see nurses do this.
    Again, there is no stiff rules in how we should react to every situation presented in our daily practice. But protocols and policies are in place to guide us in what do within reason.
    Thanks for this brainstorming situation you presented John.
    Bu the way.. I am not from an English-speaking country. I hope typos would not be a big issue as long those who we work with are on the same page.
  11. by   TriciaJ
    Quote from John 2018
    I believe you are a senior nurse with rich experience.

    The paragraph you wrote here is quite good, except two typos.

    One sentence from your paragraph, "if the dose she is getting is over 20 units and her BGL is <5. I will withhold the dose and refer."

    It wouldn't be "withhold". It can be "delay".

    Another sentence from your paragraph, "if her BGL is 4 or 4.2 I will still withhold her dose."

    It wouldn't be "withhold". It can be "delay".

    Thanks.
    Wait, you got someone to do your homework for you and you critique her writing? Are you too lazy to even proofread and rewrite it before you hand it in as your own?
  12. by   elkpark
    Quote from TriciaJ
    Wait, you got someone to do your homework for you and you critique her writing? Are you too lazy to even proofread and rewrite it before you hand it in as your own?
    He did that on another thread, too. Asked a question and then criticized the one poster who attempted to respond for not answering the way he wanted.
  13. by   caliotter3
    In my neck of the woods, the term "withhold" is used by doctors and nurses alike. But who are we to say? The OP is the expert who seems to be baiting on this website. Should return to SDN for another laugh.
  14. by   John 2018
    Quote from caliotter3
    In my neck of the woods, the term "withhold" is used by doctors and nurses alike. But who are we to say? The OP is the expert who seems to be baiting on this website. Should return to SDN for another laugh.
    To caliotter3:

    I recommend you to read the code of conduct and ethics. Please don't mislead others with inappropriate behavior.

    Your understanding about "withhold" is not good.

    Please don't mislead others to make wrong judgement. "withhold" and "delay" are totally different.

    There are two gold rules about insulin administration:

    1. Do not withhold insulin due to previous hypoglycaemia.

    2. If an insulin dose is due during a hypoglycaemic episode, it should be delayed until the hypoglycaemia has resolved, but not withheld.

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