OVERVIEW
Unorganized notes:
- Many order sets
- Eating patients, NPO/TPN patients, tube feed patients
- Eating patients. 3 different kinds of SQ insulin
- Long acting (lantus, NPH), nutrition (TID before meals), correctional aka sliding scale (if they need extra; sensitive, average, resistant) – all in the order set, have to pick which one to use
- Start on correctional/sensitive if you don’t know how much they take at home and monitor for the first 24 hrs. Ex. They use 24 units the first day. Divide that by 2. Make one of them the long acting insulin (12 units). For the other half, divide into 3, and that’s the nutritional insulin (4U TID with each meal). Goals is that they don’t need any correctional insulin. Can decrease these numbers a little to avoid hypoglycemia.
- Can also look at glucose trends over the day and tailor it to when it’s high vs when it’s low
- They get an extra 6 units of correctional insulin. Add half to the lantus and then 1 to each of the nutritional insulin doses
- If you know what they’re getting at home, usually do about 70-80% of that while inpatient. They will also be on a diabetic diet
- In house, basically just use insulin, don’t really use they’re home meds (oral hypoglycemics)
- If NPO
- Check glucose q4h
- First day get 0
- Then start with sensitive (total amount from day before divided by 6, so give it q4h)
- If on home insulin, start it at ~50%
- If on tube feeds/TPN
- Check glucose q4hu
- Can always call pharmacy or endo (esp for DM1)
- Insulin drip
- Nursing titrates it, you put in the order once
- Check glucose q1h
- Don’t use on patients eating
- If patient hypoglycemic
- 1amp of 25cc of D50, push once and check 15 mins after
- Give another amp if it doesn’t improve and check again 15 mins after
Page Updated: 06.19.2018