Nursing Practice Patterns: Timing of Insulin Administration and Glucose Monitoring in the Hospital

Abstract

Purpose The purpose of this study was to describe diabetes nursing practice patterns related to the timing of morning insulin administration, blood glucose monitoring, and meal intake for patients with type 2 diabetes and to report how frequently nurses were able to meet the expected standard of care. Methods Observations were made of 50 incidents of morning diabetes care on medical-surgical units in an acute care setting. Timeliness of rapid-acting insulin administration and glucose monitoring in relation to the morning meal were evaluated, as were the subsequent prelunch glucose levels. Results Patients did not receive rapid-acting insulin with in the standard recommended time of 10 minutes premeal/postmeal 84% of the time, nor did they receive glucose monitoring within the recommended 30 minutes premeal 57% of the time. There was no significant relationship found between timely insulin administration and glucose monitoring. There were no significant relationships found between care activities and prelunch glucose control or glucose variability. Conclusions Coordinating insulin administration, glucose monitoring, and meal delivery within the tight time frames required for rapid-acting insulin is a significant challenge not being met. Timeliness of diabetes nursing care is not the sole determining factor to good glucose control in hospitalized patients. Standards regarding timing of these activities need to be evaluated.