When to give insulin?

[kriegerkriegr]

When it comes to diabetics and giving insulin, I have seen a few methods out there:

-give the insulin only at meal times or at least have snack and juice in front of the patient.

-give the insulin at the time after the accucheck even if no food is in front of them.

I just wonder what the best way is and whats the rationale behind it?

For example, I was at the hospital last week for clinical's for school. A patients BS was 356, so according to the sliding scale, he was to get 8 units of Novolog. The nurse would not give it to him until dinner had arrived. Is that standard practice?

Help?

[bclem05]

@smleahy11 Thanks for the insight

[JM284]

If you check pt's sugar and it's 220 but they say I'm going to eat in about 2 hrs. should you hold their humalog coverage and recheck before they eat then cover them? seems like this changes per facility but shouldn't it be about BG and insulin?

[ElenG]

Hi AllynaBerry, thank you for your input. The insulin is truly one of the most misunderstood meds. I am now still in school and they teach us to administer rapid-acting insulin strictly before meal (5-15min). However, when I am at clinical I see the real nursing - administering insulin after meal. I personally think to administer after will be safer to avoid hypoglycemic risk in case pt will not eat much or anything. But I have a concern and would like to ask you - How safe it is to give insulin right after meal? How dangerous hyperglycemia for a short period of time? Thank you! You response is very valuable for me!

[Blackcat99]

Most nursing homes I have worked at, the policy is to do blood sugars around 5am and start giving insulin from 5:15am to 6:00am. All insulins are given at that time. It doesn't matter if it is long acting or short acting. The problem is that they don't start passing out trays until 7:30am. The day shift gets very angry and upset with night shift if they(day shift) have to do any blood sugars or insulin.

[CapeCodMermaid, RN]

I've worked in 14 different nursing homes. I have never seen insulin given between 5:15 am and 6am. Most places start giving it after report and count so the breakfasts are given between 7:30 and 8:30.