Pre-Prandial Glucose Monitoring and Insulin Administration

Pre-Prandial Glucose Monitoring and Insulin Administration


Name: Lucinda Agyeman

Rank: 1LT

Presenter/Poster: Both

Year: 2018


PURPOSE OF STUDY: To improve glycemic control through timely insulin administration in relation to meal consumption.


OBJECTIVE OF THE STUDY: Will implementing a standardized protocol for timing blood glucose checks, insulin administration and meal delivery for inpatient diabetics improve blood glucose control compared to the current practice during the hospital stay?


BACKGROUND: Patients with diabetes mellitus require a multidisciplinary approach and good diabetic control, such as diligence in glucose monitoring and insulin administration in relation to meal consumption. In the article by Cobaugh, D. J. (2013), a panel of experts listed recommendations for inpatient diabetics which stressed the need to improve diabetic patient care through better coordination of glucose monitoring, meal delivery, and insulin administration. Cobaugh also suggested coordinating with nutrition to alert nurses when food is on the way, further patient education, and the use of signs to better coordinate blood sugar checks with food delivery and insulin administration (Cobaugh, D. J., 2013).   


We have found that lack of communication between healthcare staff, patients and nutrition personnel cause diabetic patients to receive their meals prior to their blood glucose monitoring. Studies suggest that blood glucose levels and insulin administration should take place prior to meal time (American Diabetes Association, 2013).  Syncing insulin administration with meal tray arrival is vital in the management of type 2 diabetes mellitus during hospitalization.

STUDY METHOD AND IMPLEMENTATION: The unit collected data for a period of one month to determine the rate of missed glucose checks.  Following the month of data collection, the unit implemented signs on patients’ doors informing dietary staff to deliver meal trays to the nurse’s station. The nurse then confirmed blood glucose testing was performed, administered insulin and delivered the meal. Following this intervention, three months of post implementation data was collected.


PROJECT FINDINGS: During the one month pre-implementation data collection, there were 14 patients who received their meals before their blood glucose levels were checked. After implementation of the diabetic signs, only 4 patients received their meals before their blood glucose levels were checked. 1 of the 4 missed was due to staff error.


IMPLICATIONS FOR NURSING: Enhanced multidisciplinary collaboration between nursing, dietary, and the patient in order to promotes safe nursing practice and improves patient care.



The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army or the Department of the U.S. Government.