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I have a case in which BS has been 54-106 mg/dL ac lunch for…

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I have a case in...
I have a case in which BS has been 54-106 mg/dL ac lunch for at least 30 days. Post prandial her BS is 70- 120. Her order is for regular insulin 4 U at lunch time. No parameters have been given for when to hold insulin. I have utiilzed nursing judgement to hold the insulin as I do not want to risk lowering her BS to cause hypoglycemia. I have requested an order to hold insulin when BS < 150, as pt. BS have been WNL since supplemental GT feedingss have been stopped. There are other members of the team who are quite adament that I should administer the insulin regardless of the normal to low blood sugars as it is a doctor's order. What are your thoughts?
Submitted: 8 years ago.Category: Medical
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6/10/2010
Doctor: DrRussMD, Board Certified Physician replied 8 years ago
DrRussMD
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You are still high sometimes and are not describing symptoms of hypoglycemia. Accuchecks are often not that accurate at the low end. The wide range would indicate inaccuracy.

However, hypoglycemia is dangerous and you are correct to be concerned.
Get an order for a hemoglobin A1C which will give you an average take on control for the past 2 or 3 months.

Get a blood draw the next time it is low to see if it correlates.

Good Luck
dt
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Customer reply replied 8 years ago
What do you mean sill High? I need toknow if you would administer insulin or hold?
Doctor: DrRussMD, Board Certified Physician replied 8 years ago
Still within normal post prandial on the upper end. However, as you suspect, this might mean that the lower end is too low, although this could be inaccurate measurement. However, you should not take the chance in my view, if forced to make the decision, since hypo glycemia is way worse than an elevation.
If they will not let you hold it, I would correlate it with a blood draw for proof.
An HA1C will probably demonstrate that control has been adequate as it is.
So I would say, if you have no other choice to resolve this, hold and monitor the blood sugars; safest thing to do in my view.
dt
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