Blood sugar high, give more insulin. Blood sugar low, give less insulin. See, how hard could it possibly be? Even a trained monkey with half a brain could do it. What could possibly go wrong if you titrate your patients' insulin dosing based on the recommendation of some random dude in a Facebook group claiming to be an "endo NP"? It's not like the patient could develop uncontrolled hyperglycemia and go into diabetic ketoacidosis (DKA), or become hypoglycemic, lose consciousness in an unfortunate place, and die before being found. Especially in an inpatient setting, a consultation with a fellowship-trained endocrinologist would be much more appropriate from a medical and legal perspective. However, this midlevel nurse practitioner by the name of "Terry Williams" (a.k.a. Terry Dampier, FNP) is trying to "stay positive". Why worry about all the intricacies of long-acting versus short-acting insulin, Lantus versus Basaglar, U-100 versus U-500, sliding-scale versus bolus, etc. when you can just consult Facebook and wait for the comment section to show up?

Terry Dampier, FNP - LinkedIn

According to NP Terry's LinkedIn, she's employed at the VA. As many of our astute readers know, VA healthcare facilities are an unfortunate bastion of full practice authority for midlevel nurse practitioners, to the chagrin of physicians and the expense of patients.

NP just feels like insulin shouldn’t be started yet
Starting a patient like this on metformin is like pissing into the wind.

NP Terry obtained her FNP degree at Maryville University. We've covered this esteemed institution's FNP program in detail previously. Suffice it to say, knowing how to manage diabetes does not seem to be a strong suit among graduates of this online, 745-clinical-hour program!