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?

[BostonFNP, APRN]

There are other reasons to hold Metformin but a BS of 149 isn't one of them.

[Ahseepnwithpassion]

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

I am a bit new the forum, but this is what nursing is all about, we should be able to this sort of bouncing of one another at work but it doesn't always work that way. Thank God for allnurses. I am also a recent graduate, I passed my.NCLEX in 2009. I have found that I must have confidence in my knowledge as well as myself. I live in the state of Ohio, and I believe that you can hold a med d/t nursing judgement but in this same instance I would cyt(cover your tail) and call the doctor. I would also be prepared with recent blood sugars, he/she may want to adjust the medication. This is a doctor's order. Also taken into consideration is the was AC or HS. Again, we are all learning, nurses never stop learning. This is why we have CEU's. Also knowledge of your states nurse practice act is imperative.

[Ahseepnwithpassion]

I apologize all those typos, ugh :-(

[BlueLightRN]

Reasons I'd hold Metformin: Patient is going to have IV contrast soon or has recently had it (like less than 48 hours), has consistently low sugars (less than 80ish) or is going to be fasting for 24 hours or something. No reason to hold for BS of 140ish otherwise.

[Cuddleswithpuddles]

In the case you have described, I would have given it.

Ask your supervisor why she would have withheld it though. She may have had prior experience with this patient and the patient had a bad reaction, or maybe she can learn from your rationale. Either way, it is always good to keep an open line of communication even in disagreement.

[Cuddleswithpuddles]

Reasons I'd hole Metformin: Patient is going to have IV contrast soon or has recently had it (like less than 48 hours), has consistently low sugars (less than 80ish) or is going to be fasting for 24 hours or something. No reason to hold for BS of 140ish otherwise.

Agreed. These would be my rationales as well.

[Lev, MSN, RN, NP]

At my hospital, patients who are on sliding scales of novolog do not get treated with insulin until their blood sugar hits 150. If my patient was on a sliding scale and metformin and his/her blood sugar was 149, I would definitely give the metformin and depend on the metformin to normalize their blood sugar. I would make sure they were eating dinner before giving it. I would consider holding metformin if the blood sugar was below 100.

[SHGR, MSN, RN, CNS]

Reasons I'd hold Metformin: Patient is going to have IV contrast soon or has recently had it (like less than 48 hours), has consistently low sugars (less than 80ish) or is going to be fasting for 24 hours or something. No reason to hold for BS of 140ish otherwise.

Any of these reasons, or a creatinine level over 1.5 (males) or 1.4 (females)- source Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency

Keep in mind that Metformin is NOT A HYPOGLYCEMIC. It increases the body's sensitivity to insulin (either endogenous or exogenous) and prevents the liver from inappropriately releasing glucose into the bloodstream.

So it would appear your supervisor is indeed misinformed about the actions of this medication.

[himilayaneyes]

I would have still given the metformin. There's little chance of hypoglycemia with use of metformin. You also have to consider other factors such as is the patient eating, hx of frequent hypoglycemia, etc? If uncomfortable, you can give it and recheck the sugar later.

[Nola009]

Thank-you, that's what I was thinking, but this new supervisor said to hold it, so that's what I did. She was orienting me in a new area of all LTC paitents that she was familiar with. I did all of my nursing school clinicals in an acute care setting, and this place seems so much more relaxed (too relaxed for my taste) than the way we were trained in school. I really wish that hospitals would hire new grads. With 20+ paitents, I don't feel like it's a really safe set up, just bc of the # of people I'm providing care to on a shift.

[SHGR, MSN, RN, CNS]

With 20+ paitents, I don't feel like it's a really safe set up, just bc of the # of people I'm providing care to on a shift.

It's not the ratio that makes it unsafe.

it's the lack of evidence-based practice and knowledge among the leadership.

[CodeteamB]

Any of these reasons or a creatinine level over 1.5 (males) or 1.4 (females)- source Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency Keep in mind that Metformin is NOT A HYPOGLYCEMIC. It increases the body's sensitivity to insulin (either endogenous or exogenous) and prevents the liver from inappropriately releasing glucose into the bloodstream. So it would appear your supervisor is indeed misinformed about the actions of this medication.

Bingo!