Give regular insulin 30 units every am?

[Blackcat99]

I saw this routine insulin order at my LTC for the night shift to give at 6am. There is no parameters as to when to hold the insulin. It's just the routine insulin order for night shift to give at 6am. Breakfast trays arrive at 8am. Do you see orders like that very often? The night nurse said his blood sugar was 70 at 6am.

[AtomicWoman]

Critical thinking also means understanding the pharmacokinetics of regular insulin. Regular insulin will have an onset in approximately 30 to 60 minutes and peak anywhere from 1 to 5 hours, depending on the person (and your medication reference). 30 units is a pretty sizeable dose, and I would not want it peaking before the patient gets breakfast, not with a BG of 70, that is. With breakfast 2 hours away, holding the insulin is the safest thing to do. Holding it at 6 AM does not mean she will not get her daily dose of insulin; it means she should be reassessed later, her BG rechecked by day shift and then get her insulin if it is safe. If the low morning BG starts to look like a pattern, then her regimen should be re-evaluated by her prescriber, I agree. I also did not see it stated that this person was a Type 1 diabetic, but that would not change my thinking with a BG of 70. Is this insulin safe to give NOW would be my main concern. If not now, then when will it be safe?