Diabetes/TPN

Well my life this summer will be consumed by two things: diabetes education and TPN orders. Of which there are an excess of at the hospital. As an overall estimate it seems 75-80% of the hospital population is diabetic. Almost every time someone comes in with diabetes we are consulted for an education whether it is appropriate or not. For example we had a patient come in for a total gastrectomy and the day he got out of surgery we got a diabetic teaching consult. This guy could not have been less interested in what I had to say. Plus most of the patients we provide education for have been diabetic for years and know what to do but just choose not to comply.
As I mentioned previously TPN is used on pretty much everyone here. Rarely do they start a patient on TF over TPN. Yesterday we actually had a doctor try and write the TPN order (he didnt just check the standard like they normally do) but he added 4 units of insulin because TPN can cause a spike in blood glucose. The problem in this case was the patient did not have diabetes and her glucose was at a 73. As a result her glucose plummeted to 24-25. At that point he realized maybe he should consult the dietitian on the proper TPN formula to provide the patient. The funny thing is we had already put our suggestion in the chart and they had been "overlooked". So we decided for my QI I am going to be looking at how often the doctors follow our suggestions.