Max dose for humalog?

Nurses Medications Nursing Q/A

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I am new to nursing! I just started my new job and this is my third week. I had a new patient who is overweight and she receives a scheduled 24 units of humalog insulin before meals. I was nervous to give her this much insulin because I've never given this much before and her BG was 134. I went to my supervisor and explained to her my concern and she said to give it anyways. Was I just worried for nothing? Because my supervisor never gave me a clear explanation why it was OK, but said it was ordered.

18 Answers

TheCommuter, BSN, RN

102 Articles; 27,612 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Michelle King said:
I had a new patient who is overweight and she receives a scheduled 24 units of humalog insulin before meals. I was nervous to give her this much insulin because I've never given this much before and her BG was 134.

Let's explore this situation with critical eyes...

The physician who prescribed 24 units of Humalog with meals didn't simply whip out a crystal ball and conjure up that dose overnight. It probably started as perhaps two, three or even five units with meals. However, once the patient continually failed to achieve good blood glucose control, her physician likely titrated it upward to a dose that finally facilitates good BG control.

I have had badly overweight patients receive 50 units of Humalog with meals in addition to 100+ units of Lantus or Levemir insulin every 12 hours. Insulin resistance is a son of a gun...

blondy2061h, MSN, RN

1 Article; 4,094 Posts

Specializes in Oncology.

Insulin is titrated to an individual patient's need by working the dose up over time to get the desired, in range glucoses. Every body has varying insulin sensitivity. This patient likely has long standing type 2 diabetes and is very insulin resistant and no longer has much, if any, natural insulin production. Therefore, with meals, she needs a fair amount of fast acting insulin, such as humalog, to prevent her blood glucose from rising. If she has been on this dose and isn't having low glucoses, then it is not too much for her. Reasons not to give it and to question the dose with the physician would be if she wasn't eating, wasn't eating as much as normal, was exceptionally active, if a new long acting insulin or oral antidiabetic medication was added, if something that may make her blood glucose higher than normal was being lowered- such as steroids, or TPN, or tube feeds, or if her glucose was low before you began. Insulin really doesn't have a maximum dose. It's titrated to individual effect. Some people require exceptional amounts.

While that's a somewhat unusual dose, it's not unheard of. I would use caution the first few times when administering it, though ...especially if the person is from home. Peoples' diets are often very different in the hospital than they are at home.

Stella_Blue

216 Posts

Specializes in Emergency Nursing.

Ive given double this to a res with each meal plus 100 units of lantus BID with BG still in the high 200s

KatieMI, BSN, MSN, RN

1 Article; 2,675 Posts

Specializes in ICU, LTACH, Internal Medicine.

The maximal dose of pretty much of any insulin, including humalog, is " just enough of it".

Read about insulin resistance and why it happens. Yes, human pancreas normally makes close to equivalent of 50 units of rapid insulin/24 hours but due to insulin resistance a particular patient may need 200 units to keep blood glucose under control.

NOADLS

832 Posts

You could ask the patient how long they've been on insulin.

You could test their blood sugar at humalog's peak.

24 units of humalog will do different things to different people, even if they are starting at the same blood sugar.

Specializes in orthopedic/trauma, Informatics, diabetes.

We have had pts so insulin resistant that there were on insane amounts of insulin-20+ units of U500 insulin.

Specializes in Cardiology and ER Nursing.

Hell I've given 280 units of Humalog to a patient before.

Specializes in NICU, ICU, PICU, Academia.

Insulin resistance is why they make U500 after all.

ohiobobcat

887 Posts

Specializes in ED, School Nurse.

I am a school nurse and one of my student's routinely gets 20+ units of Humalog before lunch. He is a Type 1 diabetic with rotten control. Not unheard of at all.

Specializes in ICU.

Different setting, but I once had a patient on an insulin drip that I got up to 79 units per hour before I left that morning... and I never did see the blood sugar drop below 660. It was actually still going up. The amounts of insulin I have given is mindblowing.

Specializes in LTC Rehab Med/Surg.

I've given 500 units. My hands shook when I did it, but that's what they took at home. It's the only time I've used U500.

The patient thought I was funny.

It took a shift or two to lower that dose as their condition improved, and the restricted diet caught up with us.

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