“To Cover or Not To Cover” the Relationship of Point-of-Care Testing Through Insulin Delivery for Glycemic Control.

Abstract

Diabetes increases the risk for disorders that predispose individuals to hospitalization, including coronary artery, cerebrovascular and peripheral vascular disease, nephropathy, infection, and lower-extremity amputations (Association, 2013). Blood glucose control has been as essential part of inpatient diabetes management for years. This literature review suggests the traditional sliding scale insulin and the timing of blood glucose measurement do affect the required sliding scale dose. Current practice has night shift nurses (7pm-7am) performing point-of-care glucose testing between 5 to 6am, with the day shift nurses (7am-7pm) giving the sliding scale insulin before meals (8:30-9am) using the results obtained from the prior shift. This could be problematic because of physiologic changes and of insulin administration, the timing and dosing are critical for proper glycemic control. The Institute for Clinical Systems Improvement guideline for the diagnosis and management of type 2 diabetes mellitus in adults (2014), suggests that blood glucose readings should be taken and regular insulin ideally should be given at least 30 minutes before a meal to provide a better match of the insulin peak action with post-meal hyperglycemia. Despite the recommendations, current clinical practice falls short of these goals.