1 / 8

Glycemic Control Nurse Practitioner

Glycemic Control Nurse Practitioner. K. Ann Caudell , PhD, ACNP - BC. Identify patients with out-of-range CBGs Assist in maintaining CBGs between 80 mg/ dL & 180 mg/ dL during hospitalization

howie
Download Presentation

Glycemic Control Nurse Practitioner

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Glycemic Control Nurse Practitioner K. Ann Caudell, PhD, ACNP - BC

  2. Identify patients with out-of-range CBGs • Assist in maintaining CBGs between 80 mg/dL & 180 mg/dL during hospitalization • Assist teams with insulin treatment for newly diagnosed patients or those with continued elevated CBGs • Promote the appropriate use of basal bolus insulin • Assist teams in difficult glycemic control of patient with infections, taking steroids, high glucose dialysate, and those on tube feedings • Provide a safe transition from inpatient to outpatient glycemic control Goals of Service

  3. Weight-based calculation • Wt. X .2 for patients with renal insufficiency • Wt. X .3 - .5 for patients of normal weight • Wt. X .6 for patients overweight • Wt X .7 - .8 for obese patients For those patients newly diagnosed, start with conservative doses to determine patient’s sensitivity (or lack of ) to insulin. Newly Diagnosed Patients

  4. For patients on steroids, evaluate CBG trends • Frequently will have  CBGs throughout day • NPH recommended in this case to provide coverage for ~ 12 hours Steroids

  5. Infections  CBGs • Increased insulin requirements • Calculate total daily insulin requirements including correctional doses to determine basal and nutritional doses Infections

  6. Represents a challenge for glycemic control • Issues include • temporary tube feeding catheters such as Dobhoffs due to frequency of occlusion or misplacement • nocturnal tube feedings when patient beginning to eat meals in that nutritional insulin is considered for meals but not during nighttime feedings • In this case, can continue to give correctional doses every four hours, or regular insulin every six hour Tube Feedings

  7. When more permanent feeding tubes are inserted, can consider the following: • Determine patients insulin requirements and determine basal and nutritional doses • Nutritional dose options include: • Lispro every 4 hours • Regular every 6 hours • NPH every 12 hours • Eventually putting all insulin doses into the basal insulin • This requires careful monitoring • During periods of the patient being NPO, D5W should be administered at the rate of the tube feeding and all nutritional doses should be suspended Tube Feedings

  8. K. Ann Caudell • Cell phone: 505-238-2849 • Pager: 951-2007 • Availability 9:00 AM to 1:00 PM • If after 1:00 PM, please contact internal medicine • Please either call my cell or page me if you need assistance. Contact information

More Related