Okay, here is the question and I really need help on this.
Doctor's order: AM dose: Humulin NPH 15 units and Humulin regular 5 units SC. The AM blood sugar is 230. How much total insulin should be given?
Blood Sugar Regular Insulin
0-180 0 units
180-200 2 units
200-220 4 units
220-240 6 units
>240 Call Physician
The reason I am asking is that we don't technically have a Pharm instructor. We had someone thrown in to teach the class that has never taught before and so everyone is pretty much trying to help each other. On top of everything else, she told us she is dyslexic so we have alot of fun trying to review our notes after her classes. Personally I think the patient would get the regular dosage of 15 U and 5 U, but do I have to take the sliding scale into account or not at this regularly scheduled time or recheck in a couple of hours and if the levels are still up then use the sliding scale?
Apr 25, '04
Quote from CyndiW35055
Personally I think the patient would get the regular
dosage of 15 U and 5 U, but do I have to take the sliding scale into account or not at this regularly scheduled time or recheck in a couple of hours and if the levels are still up then use the sliding scale?
Just a quick note, that in your notes you should not use the word "regular" unless you are referring to the actual insulin, especially since the pt. is getting Regular insulin also. My endo taught me that early on, because it can cause a lot of confusion.
Christine is correct about the sliding scale. It should be given after a blood sugar check and before the am meal, and the normal dose should be given PLUS the amount indicated on the scale.
I'm not sure how often pt. checks B.S. or should be checked, but if NOT pregnant the usual is before meals (if taking any kind of short-acting insulin, like Novolog or Humalog), and then 2hrs post-prandial. I'm a little different since I'm on a pump (only pumps Novolog - no long acting), and I test 10x/day.
If the pt. is inactive (ie. bedridden), then will require higher doses, hence the sliding scale. Also, illness is a stress on the body, and stress makes the blood sugar rise. I know even a migraine can cause my B.S. to go WAY out of whack, and I programmed a special basal rate into my pump for such times. To make sure the sliding scale is appropriate, the doc should have left orders to test 1 or 2 hours post-prandial. That way after a normal ADA meal, you will know if the scale itself needs adjusting.
Last edit by RedSox33RN on Apr 25, '04