The Pediatric Diabetes Protocol at Stead Family Children’s Hospital
The various rules and established target blood glucose target ranges lend themselves well to the protocolization of diabetes mellitus management in the inpatient setting.
The University of Iowa Stead Family Children’s Hospital has established nursing policies for the inpatient management of pediatric diabetes mellitus. These policies are based upon the Division of Pediatric Endocrinology’s agreed-upon set of rules that are used at this institution. Such policies may be slightly different at other institutions, so it is important to take the time to familiarize yourself with our institution-specific protocols.
The diabetes-specific nursing protocols at UIHC can be found on the UIHC Policy Resources website (https://thepoint.healthcare.uiowa.edu/sites/UIHCPolicyResources) and searched for under the “Policy Tech” link. These include:
- Bedside Blood Glucose Monitoring in the Acute Care Units – DN.P.CWS.03.050
- Glucagon – DN.P.CWS.10.130
- Hypoglycemia Treatment in Patients with Diabetes – DN.P.CSW.13.030
- Insulin Administration – DN.P.CSW.10.200
While nursing protocols are in place for routine pediatric diabetes mellitus management, there are times when non-protocolized blood glucose checks or insulin administration is necessary. This is especially true for ill or unstable patients with diabetes who are at increased risk for more unpredictable changes in their glycemic control.
General Tips For Success:
- Maintain close communication with your bedside nurse for the entirety of the patient’s inpatient course.
- You may consider asking the nurse to tell you each blood sugar at the time it is obtained
- This keeps you up-to-date in real-time about what your patient’s blood sugar is doing even when you may be busy doing other things or away from the computer without easy access to these numbers
- It allows you to quickly react to hypoglycemia or severe hyperglycemia
- You easily ask questions to the nurse about preceding events leading up to an unexpected blood glucose value.
- For any blood sugar that is not in the target range, ask yourself, “What caused this blood sugar to be out of range? Is there a pattern that is recurring where a specific change in the insulin regimen should be made?”
- You may consider asking the nurse to tell you each blood sugar at the time it is obtained
- Determine what should be done for each blood sugar that is obtained.
- Repeat the blood sugar? Do Nothing? Give carb coverage? Give Correction?
- If insulin is needed, calculate how much insulin should be given and double-check this with the nurse
- Does a correction dose of insulin need to be given for hyperglycemia at a non-protocolized time?
- Is the patient eating a 2nd dinner and therefore needs extra Carb coverage?
- Repeat the blood sugar? Do Nothing? Give carb coverage? Give Correction?
- Always confirm when the next blood sugar check should take place.
- Is it per protocol or does it need to be a non-protocolized blood glucose check?
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