Quote from np2006
I am a new nurse on Med/surg floor.I need to know some easy to learn info about administration of insulin. I don't know when I have to hold insulin based on pt meal time. I hold Insulin Novolog 12 units before dinner last night for my patient because her BS was 175 and she was on sliding scale insulin too,I gave her 10 units regular and hold novolog. The Dr. was so mad and told me that you shouldn't hold it. I checked with another experienced nurse and she told me to hold it. Please tell me how I can determine when to hold and when not to hold.
Pt really needed both--sliding scale to reduce high (before meal target BG is 110 or lower), and premeal insulin (12 units Novolog) to cover the carb content of meal.
If pt is on mealtime Novolog, sliding scale should be Novolog too. Often, these orders are written by different doctors, so they don't match. Novolog can be given 5 to 15 minutes before a meal, but regular insulin should be given 30 to 45 minutes before a meal, so it doesn't make sense to use both. Always encourage docs to use Novolog if you are taking orders. When regular insulin isn't given early enough, it won't have the desired effect.
Premixed insulin (Novolin or Humulin 70/30, Novolog Mix 70/30 & Humalog Mix 75/25 are given before breakfast and dinner. But if the doc orders Novolog (or Humalog, or Regular) and NPH separately, The ac breakfast dose can be mixed, but the second NPH dose should be given at bedtime. One of the main drawbacks of premixed insulin is that the NPH in the dinner dose may peak between midnight and 2 am and produce low BG when pt is sound asleep and less likely to wake up. If given at bedtime, peak is closer to 5 or 6 am and pt is more likely to wake up and be able to treat the low.