Would you hold Metformin fot a BS level of 149

[Nola009]

I personally wouldn't. Then again, I am a new nurse. We all know that normal BS levels are 60-100. So, the paitent was hyperglycemic. My supervisor told me to hold the Metformin for this BS reading " in tand put "held due to low BS reading of 149" in the pts chart. Is she full of it? Trying to sabbotage me?

[Cuddleswithpuddles]

How come you assumed that your supervisor is "full of it" or trying to sabotage you? Is it possible that her disagreement with your decision to give metformin was based on her nursing experience and prior knowledge of this patient?

I think so.

Some diabetics cannot tolerate a normal blood glucose level of 60-100. For whatever reason, their body has adapted to a higher range and any attempts to force their BG levels to the textbook 60-100 causes them distressing symptoms. Just to illustrate: My hospital has multiple insulin sliding scales depending on each patient's circumstances. Long-standing diabetics also come in with blood glucose target ranges created by their endocrinologist, and they vary too. Some start out at 120. Some do not require action until BG is 201.

There is no one correct answer in this case. I would have to know more. Does the patient have prescribed parameters? Is he or she eating well? What other medications is your patient taking that could also lower blood glucose levels?

[Nola009]

I am aware of the differences in sliding scales. I am talking about Metformin (not insulin), which acts on the liver, not the pancreas. Thanks.

[Cuddleswithpuddles]

My inclusion of insulin sliding scales was meant to illustrate that target blood glucose ranges vary from patient to patient.

[morte, LPN, LVN]

was this dose to be given with a meal, which is the right way, or was it at hs, which might be significant in this case.

[Nola009]

So, in your experience, would a blood sugar of 149 warrant holding Metformin? Based on my knowlege, Metformin is long acting, doesn't include parameters for administration (of course if pt was hypoglycemic, I wouldn't be giving a hypoglycemic), and doesn't act directly on the pancreas. Like I said, I am new, so I want to get the opinions of more experienced nurses. My nursing supervisor is a kind of a newbie herself, lol and she has already done some things that I KNOW aren't to be done, just based on my nursing edu.

[Nola009]

Oh, and no other hypoglycemics were prescribed for pts. She's on a Novolog sliding scale that starts at BS of 150 mg/dL

[applewhitern, BSN, RN]

I would not hold metformin for a blood sugar level of 149. (It is usually given with the morning meal.) In my state, you would need a doctor's order to hold this; otherwise, it is considered practicing medicine without a license to do so.

[MunoRN, RN]

Typically you wouldn't hold metformin for a BG of 149, particularly if they have already been on it, in which case that BG of 149 is what the BG is with the metformin already working, continuing the metformin shouldn't necessarily drop it any lower. It's also important to remember that metformin doesn't increase insulin production, it decreases glucogenesis by the liver, so it's potentialy less likely to cause hypoglycemia.

In other words, a BG of 149 in someone already taking metformin is reason to continue it, not to hold it.

[MunoRN, RN]

I would not hold metformin for a blood sugar level of 149. (It is usually given with the morning meal.) In my state, you would need a doctor's order to hold this; otherwise, it is considered practicing medicine without a license to do so.

A nurse does not need a Doctor's order in any state to hold a medication. The Doctor should always be notified of your decision, but the final decision on whether or not to give a med is up to the Nurse. The Doctor is free to give it themselves if they can't convince the Nurse to give it. Determining the appropriateness of any medication when administering is within the scope of RN in every state.

[loriangel14, RN]

I have never held a Metformin because of a patient's BS.

[RNGriffin]

I don't care if my patient's blood sugar was 59/dl I would not hold Metformin.

Did you ask your supervisor why she thought holding metformin was a good idea? You are the nurse and it's your license. You have an obligation to make decisions based on facts. Was the patient going to surgery? Is the patient septic?

There's a nice drug reference guide & physicians phone number for the questions. This question is fine to ask her, but you've already withheld the medication.

Also, why did you come to the conclusion your supervisor had it out for you? Is there a history we are unaware of?