Diabetes Basics
Have you guys noticed the new change to insulin administration for you to put the patients BG and it gives the recommended insulin dosage? Is that a feature we like?
If it not something you like, do you have a suggestion on improvement or you would like for it to go away completely?
A patient’s blood sugar is 41, they are alert and following commands and are on a diabetic diet. What PRN will you give?
Glucose tabs and repeat the sugar in 15 minutes
How long from the time of glucose check do you have to give insulin?
60 minutes
What patients will always have endocrine consults?
1. Type 1 Diabetics
2. U-500
3. Insulin Pumps
It’s okay to give sliding scale insulin and standing scale insulin at different times
No/False
True or false: I can give insulin 2 hours apart because the patient received a late breakfast tray
No, we should be giving insulin 4 hours apart because any earlier can result in insulin stacking.
I gave my patient the PRN for their 41 BG. 15 minutes later it was 49. 15 more minutes later it is 55. What should I do now?
Contact the doctor per the policy
True or False: It is okay to run everything you need for endotool off of one pump?
False.
Insulin should be primary on a pump and your carrier fluids should be primary on a second pump
How do I contact endocrine on Voalte?
1.Check Consult Notes, search name in Voalte
2. Lightingbolt on call schedule through Epic
3. On call schedule on Voalte
4. Are they signed in to care team on Voalte?
5. Search endocrinology in Voalte phone and always reach out to PA/NP first
I need an order to hold Lantus
True!
The patient’s glucose is 50, how should the CNA contact the nurse to tell him/her?
1. Call Nurse
2. Physically come find the nurse if they do not answer
After a hypoglycemic episode when do you need to recheck the glucose?
1. 15 minutes
2. 2 hours
Endotool is running. Glucose is 217. What carrier fluids are running?
Fluids with Dextrose! (D5NS, D51/2NS)
If a patient with an insulin pump comes up in the middle of the night, can they use their own insulin?
No, it is against policy. Their insulin is considered a home medicine just like any oral medication and needs to be sent to pharmacy to be stored, sent home, or verified by pharmacy if able to use non formulary.
I can give my patient juice for hypoglycemia
False
How can staff be alerted by FNS that a clear liquid diet requires FSBS?
1. Under diet orders there is a “Does the patient require blood sugar checks” section
**This is an optional section under all diet orders**
What components are included in the hypoglycemic flowsheet?
1. FULL set of Vitals (including LOC)
2. Hypoglycemia Management
3. Nutritional Interventions
3. Critical Result Reporting
What do I do if I only have one IV and my patient is on endotool and I can’t get a second?
The maintenance fluids can be attached directly to the IV and you will Y site the insulin in.
Name 3 ways to find out if your patient has an endocrine consult
1. Check order management
2. Check to see who is ordering insulin
3. Check notes
4. Check who is listed on patient care team in Voalte and in Epic
5.
I can crush glucose tabs
True!
Can we treat someone’s blood sugar based on their CGM reading?
No, we must take their blood sugar with our glucometer
What are some symptoms of hypoglycemic events?
Tachycardia, irritability, confusion, sweating and hunger
True or false: I can use a BG of up to an hour ago to treat my endotool patient
False. BG for endotool can not be used for any longer than 20 minutes
If a patient comes up on night shift with an insulin pump, what orders should I get from endocrine?
1. Pump Refill orders
2. An order that allows us to document on the MAR how much insulin they are administering.
The hypoglycemic protocol can be viewed from your sidebar on the hypoglycemia flowsheet
True