PreOp
This Lab value, checked during pre op work up, gives an idea of how well the patients blood sugar is controlled outpatient.
Hemoglobin A1c
When is the first post op blood sugar supposed to be checked?
ASAP
What is best practice for running an insulin drip that is infusing at as rate less than 30units/kg/hr?
through a PIV
My patient is on the insulin drip still and is up to the chair. They state they would rather gouge their eyeballs out than eat any food. Do shut the insulin off since they are out of bed?
NO. The patient needs to be able to eat food before you turn the drip off and transition to S.S
it is POD#3 and My patient has the low sliding scale ordered. The BG has been treated with every check but hasnt gotten any lower than about 190. What should I do?
Talk to Wendi and get orders to inrease the level of sliding scale
AM of surgery - what glucose value is ordered to be called to CTS prior to OR?
> 180
When do I start the insulin drip post op?
Once blood glucose is at or about 140
Insulin nomogram
my patient is up to chair on POD1 & is still on insulin drip. they ordered a tray so I shut the drip off. when they got their tray they took 2 bites of jello and threw up jello and all the water i let them guzzle through the night. what do I do?
turn the drip back on yo!
Its POD#3 and my patients BG hasn't been over 115 ever. they aren't even diabetic! Do I still need to be checking sugars?
Probably not but you have to continue checking as long as there is orders to. Talk with Wendi to see if its OK to d/c the order
explanation of how glucose will be managed Post Op is best explained during this time.
Pre Op Education
How do I know what to start the insulin drip at?
In the Medication Adminitration Wizard, hover over the insulin drip order. READ WHAT It SAYS! Round up or down accordingly to make your life easier.
I had insulin running for a few hours after they got back. I shut the drip off when they hit 120 cuz, idk, thats a good sugar and it was only running at 2.
Do i even need to keep checking these sugars?
Yes. the directions about BS parameters and when you can stop the checks is within the Post op order set
what kind of tray can they have for their 1st meal?
How should I enter the diet orders?
clears but request they send sugar free things or wired jaw tray
My patient is type 2 diabetic. his sugars are still pretty elevated and he requires sliding scale every check. I noticed that he takes mealtime insulin at home. Should I keep just doing sliding scale ask if I can restart his home insulin?
yes, ask about restarting home insulin. be sure to discuss what to do if home insulin is one of those fancy insulins
0530 AM of surgery my patients blood sugar is 213. My patient has been NPO since midnight for surgery today and also will not be eating all day. however they have sliding scale insulin to treat F2hr PC blood sugars. What do I do?
TREAT THE BLOOD SUGAR!
Surgery said they had it running at 2 units/kg/hr but shut it off mid surgery. Should I just start it back at 2 or 75% of that?
treat this situation as if you were starting the drip fresh
The patients blood sugar is 85 but at the staff meeting they said we have to keep it running til the patient eats. Insulin is only at 1 but what am I supposed to do when it gets below 70? and follow the hypoglycemia order set Give Dextrose?
Yes, the non DKA insulin order set needs to be followed up until the patient tolerates food. The insulin drip itself is only 1 piece of that ordersets pie...
My patient was extubated 3 hours and says hes hungry! Feed Me! what should I give him?
explain how the diet is advanced post op and the reasons for why we do that. if absolutley neccessary give them a sugar free jello and keep the drip on
My patient is refusing insulin now on POD#4 but he really needs it, his BG is 204. He says he doesnt want to have to take insulin at home and he just needs to go back on his metformin. what should I do?
educate on the process of in hospital Post op blood glucose management and that taking insulin inpatient does not mean they will need to continue outpatient
my patient has a CGM and request for his blood glucose to be checked via that device. Is this allowed?
No!
When can I shut off the insulin drip?
once the patient is up in the chair and has tolerated food intake
Ok, my patient got up and ate broth and a popcicle with a Sprite. Tolerated that well. The insulin drip is still on. what is the next step
SHUT it off. Get sliding scale insulin orders from Wendi, d/c the insulin drip order set, check BG in 2 hours, treat if neede and keep it movin!
Who do I get orders regarding Insulin from?
CTS