C3.2 R4(c): Clarify a medication order with a prescriber

ID: DMP is a 57 yo female admitted with DKA, secondary to stopping her diabetic medications 6 months ago

She was treated with an IV insulin infusion which was discontinued yesterday. At that time, she was put on insulin glargine 14 units SC once daily, insulin sliding scale and re-started on metformin 1000mg PO twice daily. She went back into DKA and her IV insulin infusion was re-started later that day.

Clarified with prescriber if he wanted to hold insulin glargine 14 units SC once daily, insulin sliding scale and metformin while patient was on infusion. Prescriber confirmed that he wanted to hold metformin and insulin sliding scale, but not insulin glargine. (Some evidence that if putting a patient on basal insulin while on insulin infusion can increase success of them getting off insulin infusion. Since patient has already failed to come off insulin infusion, he wanted to leave the glargine on).

Pharmacy Clarification Order:

  1. Hold Metformin PO while on insulin infusion
  2. Continue with Lantus as ordered.

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