When to give insulin? - page 3

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... Read More

  1. by   phillycpnp-pc
    And with pediatric diabetics espeically toddlers, i give the fast acting insulin after they eat their entire meal (post dose)because they usually have tantrums/food adversions and not eat what is infront of him and we have to find something else they will eat. And their BG will drop if they get insulin before hand while someone is running around rerording food and looking for something else for them to eat.
  2. by   nurs1ng
    i believe u give aspart immediately after a meal
  3. by   SHGR
    The very fast acting insulins can be given right after a meal, especially in the above type of instance (when you are not sure what will be eaten).
  4. by   SHGR
    Quote from CDEWannaBe

    Fast acting insulin (Humalog, Novolog, Regular) usually takes about 15 minutes to be active, then works for 2-4 hours.
    The above is incorrect.

    Novolog, humalog, and apidra (the fast-acting analogs) have more similar onset, peak, and duration, and are essentially interchangeable. Regular is different. It takes longer to start working, peaks later, and lasts somewhat longer. We only use regular anymore for cost reasons. I find no other reason to use regular for ongoing home use. The newer rapid-acting analogs are much easier to titrate, better control a postprandial BG, and have less risk of between-meal lows.
  5. by   CDEWannaBe
    Thanks for correcting my typo hey-suz. Regular shouldn't be included with the super fast actings like Humalog and Novolog.

    I've actually been an insulin user for 35 years (diagnosed at age 4) and have used all of these insulins at one time or another. I remember when Regular was the new, high tech fast acting. =) I'm pretty insulin sensitive so Regular would usually be active for me in about 20 minutes, which isn't that different than the super fast acting hitting my system in 15 minutes. Where I notice the difference is that the Humalog I use now is out of my system in about 2 hours. It's great not to have that Regular lingering around for 4+ hours and I have a lot fewer lows because of it.

    You're smart to recommend that the super fast acting can be given right after a meal. It's the best way to avoid lows and dose accurately. The only time I took Humalog before eating was when I was pregnant and wanted to avoid any post meal rise.
  6. by   AllynaBerry
    My approach to the use of Novolog and Humalog was to give the dose after the tray was already in front of the patient - if they are eating well. If they might not finish their entire meal, wait until after they finished eating whatever they were going to eat, then, give according to carb counting ratio set by the CDE/RD.

    I was a CDE for 10 years and soon discovered that insulin was (ans still is) the most mis-understood medication out there. There are more med errors related to insulins than any other medication -- that include errors by health care professionals as well as patients and families.

    As for sliding scale, a better way to think of it is as a "correction dose"...meaning, to bring a high BG back down to a range that would be closer to "normal". It is not intended to cover food intake.

    When I served as Clinical Educator, this was a topic that had to be repeated often. The "older" nurses tended to still think of Regular Insulin and were confusing the "newer" nurses who were too unsure of themselves to argue or do something opposite of the rest of the nurses on their shift. I would find them holding Lantus/Levemir for low BG's, waiting to give sliding scale until trays arrived, and not wanting to treat lows too close to meal time...or holding mealtime insulin after treating a low an hour or two earlier.

  7. by   CapeCodMermaid
    I work in long term care. Our docs still order sliding scale insulins 4 times a day which has been shown to NOT improve quality of life. They order the sliding scale coverage for 630 1130 430 and HS. Trouble is, the breakfast trays don't come till almost 8 am. We got cited by DPH for not following the manufacturers' guidelines of giving fast acting insulin 15 minutes before a meal. Everyone has their own opinion and everyone can cite a study or two. Insulin regimins need to be based on the individual person.
  8. by   curetype1
    Sure would make the patient and RN's life easier (not to mention a healthy happy patient) if the brittle and even not so brittle type 1 diabetics would/could be on insulin pumps.
  9. by   bclem05
    Hi guys, I'm really interested in how you deal with morning glucose checks. I work on a busy tele floor, currently night shift is doing the morning glucose checks and coverage around 6 AM, trays aren't passed till around 730. As you can see this is problematic. A little background information, my hospital is still stuck in the past in regards to DM management in that only about half of the patients have basal coverage although we are starting to see more and more and the majority of blood glucose control comes from a sliding scale, typically with the use of Aprida. Also we do 12s 7 to 7. So my question is who (day or night shift) checks the blood glucose and at what time? who is administering the insulin and at what time? and how fast are trays received after insulin is administered?

    Thanks in advance

  10. by   smleahy11
    @bclem I work on a tele floor too. We do our accuchecks at the same time you do. I find that most nurses don't mind if you don't give the insulin as long as you tell them that you didn't give it. I personally do not like to give Novolog until the person is eating. I always tell the oncoming nurse, there accucheck was this, I didn't give the sliding scale. I did not want the blood sugar to drop and create a bigger problem for you. Hope this helps.
  11. by   suanna
    The problem isn't purely nursing judgement, but the doctors orders. In the case you gave- I wouldn't have had a problem giving the patient the ordered insulin- you had a LOT of room before you were in danger of a significant hypoglycemic episode. If the sugar was 86 with orders to hold or reduce the dose if bg<80 I would consider waiting for the tray to get there and making sure the patient was going to eat before I gave a dose. Same thing if I felt there was a chance they were not going to be able to eat thier normal diet. Tighter glucose control is a big core measure in hospitals right now. As everyone else has said- long acting-basilar insulins are always given, but meal coverage is best when your ordering doctors give you some latitude in nursing judgement- (If eating only liquids give only 1/2 dose, if eating <25% hold all meal coverage...)With a little flex in the order it is easier to justify waiting till the patient is eating to give the insulin. Yes- I know it is a little late- but I would rather have the insulin kick in 30 min late and have the bg spike up to 200 before dropping than have it kick in on time and have a patient "not feel like eating" and have a glucose of 60 for the next 4 hours. It's tough to suck it back out if they refuse thier tray.
  12. by   bclem05
    @smleahy11 Thanks for the insight
    Last edit by bclem05 on Jun 27, '12 : Reason: make more specific
  13. by   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?