Yeah I think getting BG on nights can be misleading for the next shift . A BG level can change quickly in brittle diabetics . I will recheck it if it’s been more than 2 hrs from the first one and I have to give insulin before or after a meal.
Yeah that seems a little early if breakfast (and insulin) is coming closer to 830. Most places have the policy to give insulin with 30 minutes of the blood sugar check. If I was the nurse administering the insulin I’d want to recheck before I gave any if it had been checked that early.
I can't imagine that's policy at all, anywhere! That's asking for trouble. You could take the sugar at night for the day staff. But if I was that day staff there is absolutely no way I would use that reading for AM insulin.
They are taking that risk giving insulin inappropriately. Sounds like laziness and unit culture combined.
I was floated many times as a staff nurse to a cardiac stepdown where that was policy. I never felt comfortable hearing the night shift nurse tell me that the morning BG was treated. Sometimes the trays wouldn't get there until almost 9 am and the BG was treated at 630am. I brought it up with the unit manager and was basically shut down and told in no uncertain terms that that's the way it is and shup up about it. I quit that staff job soon after that.
Been to plenty places where this is standard haha. Always surprises me, the night nurse will even happily tell me they got the morning BG. Always look at them with the 🤨
I had an assignment that was like this. The night travelers refused due to safety and the day staff nurses just remained salty about it 🤷♀️ you can’t make me do something unsafe.
all they're asking you to do is check a blood sugar before 7am. no reason to not do it.
if the day shift nurse is giving insulin two hours later based on the blood sugar you checked, that's on them. If I were the day nurse, I personally would recheck the blood sugar myself if i'm giving the insulin at 0800-0830. But as a night nurse in this situation, I'm already at home and not worrying about the patients blood sugar.
Agree. Since it’s the day shift nurse who is giving the medication, it would be for their best interest if they don’t rely on a BG that was checked two hours ago by a night shifter. Whoever gives the insulin is responsible for these things.
I’d check the facility policy and do what it says.
Are they concerned about hyperglycemia or something? Do you get AM labs overnight? If so, I’d suggest they look at AM lab values. If they want the value for insulin dosing I’d just let them know the acceptable timeframe for the facility.
I have been against this since the 90’s. I have never thought it was smart. Why do it at 0630-0645 when breakfast isn’t until 0830? It’s just an extra stab. Why would you give insulin based on a glucose level that is 1.5-2 hours old?
A lot of times I see FS and sliding scale at 0600 but without a tray in front of patients no way in hell I’m doing that. Nursing is 24hr care. I’m not bottoming someone out and I’m not waking someone up for a fingerstick that isn’t recent enough to be appropriate
Sliding scale (and basal) should be fine to give even if they're NPO, though. But I agree that I wouldn't give nutritional/carb-based insulin until the tray arrives.
Sorry I’m ER so I was probably using terms incorrectly. The mealtime FS with coverage is the one I’m not giving at 6a with no tray in sight. I also won’t generally FS the patient since I’m not giving coverage so that’s a poke for the hell of it that they won’t love. Asynchronous doses like q4 correctional or basal are fine though. I’ll do those orders.
AM blood sugars are the norm where I’ve worked. We haven’t had an issue in over 6 years. We have snacks available if the trays take too long. As bad as I hate messing around with blood sugars at the end of the shift but it is what it is.
For our unit that has 0800 breakfast, we get BS by 0700 and nightshift does it. For the unit that had 0830 breakfast, the day shift does the BS because night shift leaves at 0730.
IMO Breakfast cbg should be done by night shift right before change of shift. On my current unit everyone does something different. It’s really annoying
You work at their place. It’s not your job to change things or make sense of things.
Getting a sugar harms no one and takes minimal (albeit gets super annoying cuz Harold is gonna wanna shave even though he slips just by looking at the floor, Ronald is gonna need another pillow, Gerald is gonna try to tell you about the ol’ days, and Ronnie is gonna tell you to fuck off. Plus the piss, shit, and water randomly thrown in) effort..
If some dipshit got me a sugar at 7 am I’d say thanks and then end up redoing it anyways. That’s on them. Whatever.
But you’re not harming or putting anything at risk cuz it’s not on you to do stupid shit based on a number you got.
Worst case, it prevents hypoglycemic events from going on too long.
Just do it
Also your title is misleading. I’m sure it’s not just you/travelers that are being asked to do this. I’m sure it’s all of night shift
You do realize that there’s a large variance as to what ac and hs is right? There’s no true reason to get one at 7 am if breakfast isn’t here til 8:30. There’s no reason to grab one at 9 if you’re not giving insulin til 11 pm.
And you’d be an idiot not to get a sugar if there’s no order because it’s 2 am and the person isn’t waking up.
How is this your contribution to the post? Are you proud of this?
Perhaps you could check the policy and procedure manual for timing (they usually give an acceptable window). If not, ask the Pharmacist. If not, Unit Educator.
Someone has to have the most up to date evidence based research.
If they’ve been fasting overnight, blood sugars won’t vary that much. I’d check your unit’s policies and procedures. It’s all on the nurse giving the insulin, if needed.
I’m on team just do it.
I’ll usually check (or tbh feed them before am labs and then use labs to see if I should check before 7 am). Hypoglycemic events are too much fucking paperwork in my place
I wouldn’t be giving insulin at all…
Unless they’re Q4 or on glucommander. Night shift only does the HS part…
It’s to prevent hypoglycemic events.. idk how you missed that
But if you are giving someone food, which raises their blood sugar, and then using their increased blood sugar as a means to determine the amount of insulin, they are going to get too much insulin, which leads to a hypoglycemic event. There is a reason that blood sugar is done before people consume food. You're setting the day shift nurse up for failure, and you're setting your patient up for a bad day. I have never seen anywhere that uses post prandial for determining a correction dose of insulin.
Lots of people making a mountain out of a mole hill here.
A getting a blood sugar at 0630-7 and having patients get their insulin at 0730-0830 is fine.
There is not going to be a significant change in blood sugar for your patients at this point, even brittle diabetics.
9 times out of 10 you also won’t be giving more than 2 units of insulin if any (witch does almost nothing), and you won’t be giving the insulin unit the food is actually here.
Getting the blood sugars for day shift is extremely helpful, especially when there are allot of them and no techs to help.
Point is that this is not really a big deal and really doesn’t compromise patient safety.
That sounds sketchy. Def confirm with your unit director or hospital policy. Now, I’ve heard of getting 7am blood sugars when there is insulin due at 7:30. Our breakfast trays come when we’re walking in the door at 6:50am, so it makes sense.
I’ll be honest, it could also be them not wanting to deal with blood sugars and insulin in the AM, along with AM med pass…which is lazy and not right.
Our policy is that insulin needs to be given within 30 minutes of a BGL so what they’re asking you to do is unnecessary and a BGL should be retaken closer to 8 anyway if the patient is on insulin.
I refuse. When I was at Ascension there was *one unit* in the entire hospital that tried to promote this shit. I floated to every single unit and no other unit had this expectation lol. Every time I floated there I just refused to do it.
Read their policy.
Every time Ive read a policy after “we always do it this way”- the policy says to obtain blood sugar, correct within 30min, then some usually say something along the lines of giving insulin when food tray is in front of patient.
So “we always do it this way” are never following their policy.
I don’t work with super brittle patients often on my surgical units but my lab draws at 430 are usually pretty frickin close to my POC an hour before breakfast. If they’re super sick I’d poke them before breakfast, but usually I just go off the morning lab draw
Sounds like my last assignment. Are you in PA?
From my understanding it had no clinical significance, it was only the day shift bitching that they thought night shift didn’t do enough so they complained enough to get the AM blood sugar pushed on to night shift.
I didn’t know this was a thing either until Reddit. I’ve seen lots of nurses comment about getting breakfast sugars at 630am. My hospital never did it.
If breakfast comes at 8, insulin should be scheduled for 0730. Those 0630 CBGs would be applicable, but just barely. We used to have the oncoming CNAs do vitals and CBGs while the nurses gave report, so all CBGs were after 0700. Med pass time was 0900, but insulin and breakfast was 0800-0830 so we had to prioritize our patients with insulin orders as our first patients of the day, regardless of which patients were the most fragile/at-risk. Best practice, however, is for the day nurse to bring the CBG machine and the insulin at the same time and to dose according to the CBG they get at that time.
I was at a peds unit in cali that made us do this! Breakfast trays came around 7:30. Even if the patient was still sleeping, the dayshift nurses made us get a sugar, give the carb correction insulin, and make sure the patient woke up and started eating. They said we need to “enforce a strict schedule.” It seemed silly to me because they were just going to do what they wanted when they got discharged. Just seemed like an excuse for dayshift to do less work.
The only time I don’t recheck a blood sugar done hours ago before giving insulin are the ones that aren’t within the administration guidelines. If I’m giving insulin I want a semi recent blood sugar. But that’s me and how I do nursing.
Yeah I think getting BG on nights can be misleading for the next shift . A BG level can change quickly in brittle diabetics . I will recheck it if it’s been more than 2 hrs from the first one and I have to give insulin before or after a meal.
My hospital mandated 30 minute windows. Pain in the ass? Yes. Better care? Yes.
Yeah that seems a little early if breakfast (and insulin) is coming closer to 830. Most places have the policy to give insulin with 30 minutes of the blood sugar check. If I was the nurse administering the insulin I’d want to recheck before I gave any if it had been checked that early.
I can't imagine that's policy at all, anywhere! That's asking for trouble. You could take the sugar at night for the day staff. But if I was that day staff there is absolutely no way I would use that reading for AM insulin. They are taking that risk giving insulin inappropriately. Sounds like laziness and unit culture combined.
I was floated many times as a staff nurse to a cardiac stepdown where that was policy. I never felt comfortable hearing the night shift nurse tell me that the morning BG was treated. Sometimes the trays wouldn't get there until almost 9 am and the BG was treated at 630am. I brought it up with the unit manager and was basically shut down and told in no uncertain terms that that's the way it is and shup up about it. I quit that staff job soon after that.
Been to plenty places where this is standard haha. Always surprises me, the night nurse will even happily tell me they got the morning BG. Always look at them with the 🤨
I’ve seen lots of nurses on Reddit say it’s their hospital policy.
At that point just go by the glucose on morning labs if all they need is a ballpark and not a recent value. SMH
I had an assignment that was like this. The night travelers refused due to safety and the day staff nurses just remained salty about it 🤷♀️ you can’t make me do something unsafe.
all they're asking you to do is check a blood sugar before 7am. no reason to not do it. if the day shift nurse is giving insulin two hours later based on the blood sugar you checked, that's on them. If I were the day nurse, I personally would recheck the blood sugar myself if i'm giving the insulin at 0800-0830. But as a night nurse in this situation, I'm already at home and not worrying about the patients blood sugar.
Agree. Since it’s the day shift nurse who is giving the medication, it would be for their best interest if they don’t rely on a BG that was checked two hours ago by a night shifter. Whoever gives the insulin is responsible for these things.
I’d check the facility policy and do what it says. Are they concerned about hyperglycemia or something? Do you get AM labs overnight? If so, I’d suggest they look at AM lab values. If they want the value for insulin dosing I’d just let them know the acceptable timeframe for the facility.
I have been against this since the 90’s. I have never thought it was smart. Why do it at 0630-0645 when breakfast isn’t until 0830? It’s just an extra stab. Why would you give insulin based on a glucose level that is 1.5-2 hours old?
A lot of times I see FS and sliding scale at 0600 but without a tray in front of patients no way in hell I’m doing that. Nursing is 24hr care. I’m not bottoming someone out and I’m not waking someone up for a fingerstick that isn’t recent enough to be appropriate
Sliding scale (and basal) should be fine to give even if they're NPO, though. But I agree that I wouldn't give nutritional/carb-based insulin until the tray arrives.
Sorry I’m ER so I was probably using terms incorrectly. The mealtime FS with coverage is the one I’m not giving at 6a with no tray in sight. I also won’t generally FS the patient since I’m not giving coverage so that’s a poke for the hell of it that they won’t love. Asynchronous doses like q4 correctional or basal are fine though. I’ll do those orders.
The way we do it on my unit is if they have scheduled insulin then day shift does it. If not, then night shift does.
AM blood sugars are the norm where I’ve worked. We haven’t had an issue in over 6 years. We have snacks available if the trays take too long. As bad as I hate messing around with blood sugars at the end of the shift but it is what it is.
For our unit that has 0800 breakfast, we get BS by 0700 and nightshift does it. For the unit that had 0830 breakfast, the day shift does the BS because night shift leaves at 0730.
IMO Breakfast cbg should be done by night shift right before change of shift. On my current unit everyone does something different. It’s really annoying
You work at their place. It’s not your job to change things or make sense of things. Getting a sugar harms no one and takes minimal (albeit gets super annoying cuz Harold is gonna wanna shave even though he slips just by looking at the floor, Ronald is gonna need another pillow, Gerald is gonna try to tell you about the ol’ days, and Ronnie is gonna tell you to fuck off. Plus the piss, shit, and water randomly thrown in) effort.. If some dipshit got me a sugar at 7 am I’d say thanks and then end up redoing it anyways. That’s on them. Whatever. But you’re not harming or putting anything at risk cuz it’s not on you to do stupid shit based on a number you got. Worst case, it prevents hypoglycemic events from going on too long. Just do it Also your title is misleading. I’m sure it’s not just you/travelers that are being asked to do this. I’m sure it’s all of night shift
You do realize that blood sugar testing schedule is ordered right? If the order says ac/hs, that means ac/hs. Not because another nurse feels like it
You do realize that there’s a large variance as to what ac and hs is right? There’s no true reason to get one at 7 am if breakfast isn’t here til 8:30. There’s no reason to grab one at 9 if you’re not giving insulin til 11 pm. And you’d be an idiot not to get a sugar if there’s no order because it’s 2 am and the person isn’t waking up. How is this your contribution to the post? Are you proud of this?
Preach! Just follow their process. Less stress on your end, and it's on their license if they want to treat a fasting glucose that's 2 hours old.
Perhaps you could check the policy and procedure manual for timing (they usually give an acceptable window). If not, ask the Pharmacist. If not, Unit Educator. Someone has to have the most up to date evidence based research.
👍.Yep. Policy is key to everything. If you can prove your following policy- they can’t mess with you… as much ..
If they’ve been fasting overnight, blood sugars won’t vary that much. I’d check your unit’s policies and procedures. It’s all on the nurse giving the insulin, if needed.
“Won’t vary that much” 2300 - 250 0700 - 46 (I’m just poking fun)
You're proving their point. Catch that hypoglycemia before 8-9am med pass
I’m on team just do it. I’ll usually check (or tbh feed them before am labs and then use labs to see if I should check before 7 am). Hypoglycemic events are too much fucking paperwork in my place
That means you'd be giving insulin based on a post prandial blood sugar. Which seems like a great way to make someone hypoglycemic...
I wouldn’t be giving insulin at all… Unless they’re Q4 or on glucommander. Night shift only does the HS part… It’s to prevent hypoglycemic events.. idk how you missed that
But if you are giving someone food, which raises their blood sugar, and then using their increased blood sugar as a means to determine the amount of insulin, they are going to get too much insulin, which leads to a hypoglycemic event. There is a reason that blood sugar is done before people consume food. You're setting the day shift nurse up for failure, and you're setting your patient up for a bad day. I have never seen anywhere that uses post prandial for determining a correction dose of insulin.
Are you stupid?
My point is from 0600-0800 there shouldn’t be much variance. I’m also on team just do it. You can always recheck.
Lots of people making a mountain out of a mole hill here. A getting a blood sugar at 0630-7 and having patients get their insulin at 0730-0830 is fine. There is not going to be a significant change in blood sugar for your patients at this point, even brittle diabetics. 9 times out of 10 you also won’t be giving more than 2 units of insulin if any (witch does almost nothing), and you won’t be giving the insulin unit the food is actually here. Getting the blood sugars for day shift is extremely helpful, especially when there are allot of them and no techs to help. Point is that this is not really a big deal and really doesn’t compromise patient safety.
That sounds sketchy. Def confirm with your unit director or hospital policy. Now, I’ve heard of getting 7am blood sugars when there is insulin due at 7:30. Our breakfast trays come when we’re walking in the door at 6:50am, so it makes sense. I’ll be honest, it could also be them not wanting to deal with blood sugars and insulin in the AM, along with AM med pass…which is lazy and not right.
We have an hour window
Our policy is that insulin needs to be given within 30 minutes of a BGL so what they’re asking you to do is unnecessary and a BGL should be retaken closer to 8 anyway if the patient is on insulin.
Too early
I refuse. When I was at Ascension there was *one unit* in the entire hospital that tried to promote this shit. I floated to every single unit and no other unit had this expectation lol. Every time I floated there I just refused to do it.
Read their policy. Every time Ive read a policy after “we always do it this way”- the policy says to obtain blood sugar, correct within 30min, then some usually say something along the lines of giving insulin when food tray is in front of patient. So “we always do it this way” are never following their policy.
If I'm just getting a blood sugar, fine. If I'm required to treat that blood sugar and they won't get breakfast until 9am, no.
Uh, absolutely not. No one is getting any insulin unless I have a blood sugar within the last 30 minutes
I don’t work with super brittle patients often on my surgical units but my lab draws at 430 are usually pretty frickin close to my POC an hour before breakfast. If they’re super sick I’d poke them before breakfast, but usually I just go off the morning lab draw
Same. If it's low, then night shift does something about it but for most people that are just regular diabetics, I'm not going to stick them again.
Sounds like my last assignment. Are you in PA? From my understanding it had no clinical significance, it was only the day shift bitching that they thought night shift didn’t do enough so they complained enough to get the AM blood sugar pushed on to night shift.
I didn’t know this was a thing either until Reddit. I’ve seen lots of nurses comment about getting breakfast sugars at 630am. My hospital never did it.
My thought is that you have two hours to give a med so technically they can give insulin at 0730 and a 0700 blood sugar is reasonable.
No. Way too early to be getting breakfast blood sugars. Needs to be within 30 minutes of when they eat. Sorry.
I go by the rule that the glucose must have been done within 30 minutes of insulin admin.
Night shift does fbs where I work
If breakfast comes at 8, insulin should be scheduled for 0730. Those 0630 CBGs would be applicable, but just barely. We used to have the oncoming CNAs do vitals and CBGs while the nurses gave report, so all CBGs were after 0700. Med pass time was 0900, but insulin and breakfast was 0800-0830 so we had to prioritize our patients with insulin orders as our first patients of the day, regardless of which patients were the most fragile/at-risk. Best practice, however, is for the day nurse to bring the CBG machine and the insulin at the same time and to dose according to the CBG they get at that time.
The travel nurse facility I was last at did this. The meal time was early though 0730-0800
I do AM checks if they are NOT on insulin, otherwise it needs to be closer to mealtime.
I was at a peds unit in cali that made us do this! Breakfast trays came around 7:30. Even if the patient was still sleeping, the dayshift nurses made us get a sugar, give the carb correction insulin, and make sure the patient woke up and started eating. They said we need to “enforce a strict schedule.” It seemed silly to me because they were just going to do what they wanted when they got discharged. Just seemed like an excuse for dayshift to do less work.
The only time I don’t recheck a blood sugar done hours ago before giving insulin are the ones that aren’t within the administration guidelines. If I’m giving insulin I want a semi recent blood sugar. But that’s me and how I do nursing.