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Basics of Glycemic Control for Interns

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Basics of Glycemic Control for Interns

Post  Admin on Mon Aug 08, 2011 11:50 pm

Basics of Glycemic Control for Interns


BLOOD GLUCOSE METER READING SCHEDULE(S)
• Meals and bedtime – 6am, 12noon, 5pm and 10pm
• Three time a day with meals – 6am, 12noon, 5pm and 10pm
• Every 6 hours


NOTE: FOR PATIENTS IDENTIFIED AS HIGH RISK FOR HYPOGLYCEMIA SUFFERING FROM HYPOGLYCEMIA UNAWARENESS THERE SHOULD BE AN ORDER FOR A 2AM BLOOD GLUCOSE METER READING


BASAL INSULIN is defined as REQUIRED DAILY INSULIN
• Required daily insulin
• Required insulin for basal metabolic activity
• Required even if not eating
• Never hold basal insulin in Type I Diabetes (dose may need to be adjusted)
Types of basal insulin to be prescribed by MD: Lantus (Glargine) or NPH
• If Lantus (Glargine) is ordered, it is given, once a day (daily) at either 8am or 10 pm.
NOTE: LANTUS CANNOT BE MIXED WITH ANOTHER INSULIN
NPH Insulin can be ordered as now, stat, and then every 12 hours (8a-8p) or daily; daily at 8am; daily at 8pm; daily at 10am; or daily at 10pm.


PRANDIAL INSULIN is defined as MEALTIME INSULIN
• Given with meals.
• All Type I - DM patients need it.
• Some Type II - DM need it; especially those with high insulin requirements and those in the acute care setting.
• Schedule may be ordered as three times a day with meals: 8am, 12noon, and 5pm.
• Another schedule that may be ordered is with only 1 meal: breakfast (8a), lunch (12noon), dinner (5p).
• Hold dose if patient is not eating, and notify physician.
• Types of prandial (mealtime) insulin to be prescribed by MD: Regular or Analogue (Lispro)
NOTE: ADMINISTER WHEN MEAL TRAY IS AVAILABLE


CORRECTION SCALE INSULIN previously known asSLIDING SCALE
• Supplemental insulin.
• Added to prandial insulin if on basal/bolus.
• Administer at the same time you administer the mealtime insulin.
• Given periodically for NPO pts on basal only.
• Should not be used alone to control blood glucose.
• Call physician for new order if it does not match.
• Types of Insulin(s) to be prescribed in the correction scale : Human regular or Lispro.
NOTE: THE TYPE OF INSULIN IN CORRECTION SCALE MUST MATCH THE TYPE OF INSULIN PRESCRIBED IN THE PRANDIAL ORDERS.


CORRECTION SCALE INSULIN MUST MATCH PRANDIAL INSULIN.

MANAGEMENT OF HYPOGLYCEMIA
• If patient is alert & oriented give 4 to 6 ounces of fruit juice or milk. For dialysis patients, give apple juice instead of orange juice. Do not add sugar packets to juice.
• If patient is NOT ALERT or can’t swallow food by mouth → follow hypoglycemic protocol.


HYPOGLYCEMIC PROTOCOL
Based on blood sugar reading and patient alertness; one of the following three interventions is implemented:

If BLOOD GLUCOSE IS BETWEEN 50 – 70mgdL. and the patient is NPO and Not Alert:
Administer DEXTROSE 50% INJ 25 ml, IV push, PRN STAT, (1/2 ampule).
Notify physician and recheck blood glucose in 20 minutes.
OR
If BLOOD GLUCOSE IS LESS THAN 50mg/dL.and the patient is NPO and NOT ALERT:
Administer DEXTROSE 50% INJ 50 ml, IV push, PRN STAT, (1 ampule).
Notify physician and recheck blood glucose in 20 minutes
OR
IF PATIENT HAS NO IV ACCESS, AND BLOOD GLUCOSE LESS THAN 50MG/dL AND THE PATIENT is NPO AND NOT ALERT
Administer GLUCAGON INJ 1 mg, IM, PRN STAT.
Notify physician and recheck blood glucose in 20 minutes.



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