SSC w/ pt skipping meal

Ideally insulin coverage for a meal and for hyperglycemia should be calculated separately and then added together for the total dose. SSC does not do this, and therefore, you really can't give insulin coverage if someone isn't eating. Just another problem with it and reason it should be retired

The Med-Surg textbook I used in nursing school back in 1993 stated that SS insulin is given for an already high BG,, and is not in anticipation of any additional meal/food. To me this means that the SS insulin would be given even if the pt was NPO, or just did not want to eat. Usually the BG is checked ac & hs and coverage is given based on the BG at the time. Nurses often hesitate to give the ac insulin (even if the BG is 300+) if the pt is not eating, or if the meal tray has not yet arrived. Most sliding scales are the same at bedtime--even though no meal is being served--so the concept of the scale being just to correct the high BG is easier to see.

At the hospital where I work, we developed an insulin order sheet with instructions on how to order basal/bolus insulin. There is even a weight-based dosing chart with doses calculated using 0.5 units/kg and 1 unit/kg. The correction scales are at the back. So what do 90% of the doctors do? You guessed it--they go straight to the last page and order the correction scale as the only insulin coverage!