Harmful hypoglycemic events are still occurring in hospitals. Continue to utilize strategies to prevent mix-ups, such as storing U-500 insulin and supplies apart from other insulins. Use reports to identify and monitor high-risk patients, including those on basal insulin doses over 0.25 units/kg or elderly patients on a sulfonylurea. And incorporate these steps to increase other safeguards...
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Table 1. Frequency of BG Monitoring. |
Refocus efforts on your hypoglycemia order set. Make sure you have one in place and that nurses can initiate it. Errors continue to occur due to lack of a protocol or not using it. Focus on nutritional intake. Work with dietary so nurses are notified when meals are delivered. This can facilitate proper timing of insulin with meals, such as within 15 minutes of the first bite. Think about a policy allowing nurses to assess intake first and reduce or hold MEALTIME doses based on the amount eaten. For example, consider this for patients with nausea or poor appetite.
But explain that CORRECTIONAL insulin should be given regardless of intake, since it covers preprandial blood glucose. USE OUR NOTE, "Preoperative management of diabetes medications in hospitalized patients undergoing surgery". For other NPO patients, consider reducing basal doses by one-third to one-half, based on hypoglycemia risk (see Table 2).
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Table 2. Risk Factors for Inpatient Hypoglycemia. |
Prevent hypoglycemia when using insulin for acute hyperkalemia. Reevaluate the insulin dose. Some data suggest that using 5 units or 0.1 units/kg lowers potassium as well as 10 units. Verify that these orders require frequent glucose checks after giving insulin, such as every 30 to 60 minutes for a few hours (see Table 1, above). If IV insulin for hyperkalemia isn't prepped in the pharmacy, stock kits on patient units and include a Luer lock INSULIN syringe. Using a non-insulin syringe to draw up IV hyperkalemia doses is causing overdoses, since it requires converting units to mL. Start fine-tuning hypoglycemia prevention now. USE OUR NOTE, "Preventing and treating hypoglycemia in patients with type 2 diabetes" to help you getting more information.
REFERENCES
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Moussavi K, Garcia J, Tellez-Corrales E, Fitter S. Reduced alternative insulin dosing in hyperkalemia: A meta-analysis of effects on hypoglycemia and potassium reduction. Pharmacotherapy. 2021 Jul;41(7):598-607. Available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2596
ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults. [online] Available at: https://www.ismp.org/sites/default/files/attachments/2018-09/ISMP138D-Insulin%20Guideline-090718.pdf
Griffing KL. Hypoglycemia Prevention in Hospital Patients: A Quality Improvement Project to Prevent Severe and Recurrent Hypoglycemia. Clin Diabetes. 2016 Oct;34(4):193-199. Available at: https://diabetesjournals.org/clinical/article/34/4/193/31346/Hypoglycemia-Prevention-in-Hospital-Patients-A
Cruz P. Inpatient Hypoglycemia: The Challenge Remains. J Diabetes Sci Technol. 2020 May;14(3):560-566. Available at: https://journals.sagepub.com/doi/10.1177/1932296820918540