- Chris Santry, MSN, RN, CCRN
- November 19, 2018
Maintaining Glucose Targets Through the Thanksgiving Holiday
Thanksgiving is a time for celebration with family and food, but celebrating the holiday from a hospital bed is never quite as enjoyable. For those with diabetes and hyperglycemia, the holiday can either be riddled with rules to ruin the day or a free-for-all that leads to extremely high blood glucose levels. As healthcare providers, we want this time to be as special as possible for our patients. Utilizing our knowledge and tools for hyperglycemia management, we can afford to loosen the reigns on strict carbohydrate diets for many of our patients without losing sight of our targets.
Sliding scale insulin as the sole method of glucose management should be avoided.
Sliding scales provide only a reactive approach to managing hyperglycemia, and during a food heavy holiday, this can result in even higher blood glucoses and extreme variation throughout the day and night. Instead, use basal and bolus insulin therapy to provide a proactive approach. Basal insulin helps keep blood glucoses steady between meals and overnight, while bolus insulin covers the carbohydrates in the meal. Adjusting the bolus insulin dose to the carbohydrate content in the meal paired with administering the dose within fifteen minutes of the first bite, we can mimic the bodies normal physiological response to carbohydrate consumption and maintain fairly even blood glucose levels without hypoglycemia.
Teach your patients about meal timing and the action of exogenous insulin.
Because insulin analogs typically work for about 3-4 hours, we should encourage patients to space meals and snacks out about this same amount of time. By spacing meals, we can ensure the patient’s pre-meal blood glucose is reflective of having no, or very little, insulin left on board. So if the patient’s blood glucose is still elevated, we can safely administer a dose of correction insulin without risk of stacking insulin.
Encourage some light post-meal exercise.
Did you know the action of muscle movement can move glucose out of the blood and into the cells for metabolism without insulin? For those patients who are able to get up out of bed, a post-meal walk around the unit with family can have multiple positive health effects, including improved mood, better circulation, faster healing, higher energy levels and better glucose level management. Your patients and their families will also appreciate the time to get out of their room and on the path to full recovery.
Use EndoTool® SubQ to make your life a little easier.
The EndoTool SubQ application provides individualized, precision insulin dosing recommendations for patients in the hospital and provides a straightforward platform for basal and bolus insulin therapy. By inputting patient specific clinical information, as well as blood glucoses associated with carbohydrate counts from meals, the application can provide dose to dose adjustments in insulin based on patient needs. Additionally, the application will make daily adjustments to the total daily dose (TDD) when the patient is not meeting their target glucose range.
So, this holiday season, encourage your patients to eat their Thanksgiving foods with family, fun, and laughter, and rest assured, optimum blood glucose management is still in reach!
About the Author: Chris Santry, MSN, RN, CCRN is a Clinical Services Specialist at Monarch. In his role, he is responsible for supporting clients in the implementation and ongoing management of the EndoTool Glucose Management System. Chris works with clients to understand their existing glycemic management processes and protocols and address any gaps that may exist to ensure a successful implementation. Once in use, he continues to serve as a resource providing ongoing analysis and training to optimize EndoTool. Prior to Monarch, Chris was a critical care nurse at Gwinnett Medical Center and an adjunct instructor in the nursing department at Gwinnett Technical College.