I am a bit confused with insulin administer time because the nature of pts we have on medicine floor.
I understand different kinds of insulins, including their onset, peaks, and duration. I was taught in school to give regular insulin 20-30 minutes before eating, and according to our hospital policy insulin premix 30/70 (30 regular 70 NPH) is also given 30 minutes before eating.
Now the problem is, a lot of pts are confused and dont eat much at all! I can take the BS at 0730, gave the scheudled regular @ 0740 and BRFT comes at 0800 but they tell me "I dont want to eat." or they ate couple spoons and stopped. I do encourage the diabtic pts to eat and drink more, sometimes i say "Okay you can leave the toast and egg, but you gonna finish the chocolate milk/boost so you are not dehydrated and you just had the insulin" (half of the time they dont understand what im saying), also another disadvantage is that 0700-1000 is the busiest time for me, not only that i had to finish my vitals, med pass, assessments and am care but also set up/feed the pts and have my 30 minutes break. In fact, I cant really force them to eat because not eating much is fairly common among such population, as their activity level is not high during the day either.
I see some practice is...
1) give the sliding scale: regular, rapid, or premix (regular and NPH, rapid and regular) in front of the tray and watch pt start eating. Give the NPH a bit earlier before eating.
2) give the sliding scale and premix after eating. Give the NPH in front of tray.
Now my problem is:
they ate, only couple spoons. Now what? Gave the needles? So far I have not seen any hypoglycemia related to sliding scale or scheduled insulin during day shift yet, but i have seen rebound hypoglycemia at 0100 on one pt who totally lost consciousness and was bubbling. She had glucacon and d50w and then transferred to ICU.
Plz help, thanks!