Timing is everything: results to an observational study of mealtime insulin practices.
OBJECTIVE
The purpose of this study was to evaluate the timing and practices of blood glucose testing and rapid-acting insulin administration around mealtimes.


METHODS
This study used an observational, descriptive design to assess the time between blood glucose testing and insulin administration and the time between first bite of the meal and insulin administration.


METHODS
The setting was 4 cardiology units in 2 hospitals within a large community healthcare system.


METHODS
Sixty-four mealtime practice events at breakfast, lunch, and supper were observed.


METHODS
Investigators directly observed the timing of rapid-acting insulin administration at 3 mealtime periods an assessed timing of blood glucose testing, food intake, and method of glucose reporting.


RESULTS
Overall, 14% (n = 64) of the patients received blood glucose testing within 1 hour prior to insulin administration and insulin administration within 15 minutes of the meal. As separate elements, blood glucose testing was done within the defined ideal range 35% (n = 63) of the time, and insulin was administered within range 40% (n = 58) of the time.


CONCLUSIONS
Timing for meals, blood glucose testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various patient caregivers with low achievement of ideal practices.


CONCLUSIONS
Results to this study revealed opportunities for better coordination of mealtime insulin practices. Lack of coordination can lead to medication errors and adverse drug events. Further study should include effect of mealtime coordination on glycemic control outcomes and testing the effect of interventions on timing of mealtime insulin practices.
Author Affiliations: Diabetes Clinical Nurse Specialist (Ms Lampe), Orlando Regional Medical Center, Director Center for Nursing Research (Dr Penoyer), Orlando Health, Clinical Nurse-Neurology (Ms Hadesty), Orlando Regional Medical Center, CNL, Cardiac Progressive Care Unit, Orlando Health (now Assistant Professor of Nursing, Adventist University of Health Sciences) (Ms Bean), and Heart Failure Clinical Nurse Specialist, Dr P. Phillips Hospital (now Professor of Nursing, Seminole State College), Altamonte Springs (Ms Chamberlain), Florida.
Julie
J
Lampe
Daleen Aragon
DA
Penoyer
Shannon
S
Hadesty
Angelina
A
Bean
Lyne
L
Chamberlain
D001786:Blood Glucose / Q000032:analysis*; D004435:Eating; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*
D001786:Blood Glucose; D007328:Insulin