Question regarding insulin administration Question regarding insulin administration | allnurses

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Question regarding insulin administration

  1. 1 Another nurse told me something the other day that I have never heard before. I tried googling it and couldn't find anything either. He said that if you are giving insulin and you aren't sure when the pt will be eating, you can divide the BS by 50% and if it is still in a save range, you can give the insulin. He says it should never drop the sugar more than 20 - 25%, but he uses 50% to be safe. So what he is saying is that if the BS is 200 and you give the ordered SS dose, the sugar would at most drop to 100 which is still safe for the pt.

    Has anyone ever heard this before??? I was always taught to wait until trays are on the floor.
  2. 21 Comments

  3. Visit  DixieRedHead profile page
    #1 16
    Give the insulin as ordered and per protocol. What "someone told me" ain't gonna fly in court.
  4. Visit  mappers profile page
    #2 1
    Quote from DixieRedHead
    Give the insulin as ordered and per protocol. What "someone told me" ain't gonna fly in court.
    Thanks, but that doesn't really answer the question. No where did I say I would do that. My question was has anyone ever heard of this. I guess your answer is no.
  5. Visit  KelRN215 profile page
    #3 0
    The patient's sliding scale is designed to keep their glucose within a certain range. I rarely take care of diabetics and when I do, it's almost always type I (pediatrics) but all of the patients I see have sliding scales based on what the endocrinologist wants their glucose to be as well as carb correction factors. If it's a pre-meal check, why wouldn't you just wait until the food comes and give the insulin immediately prior to the meal? You need to know how many carbs they're about to consume to calculate the proper dosage anyway, if you're also carb-correcting. I know at my institution, if regular insulin is administered, it is expected that the patient is going to be eating within the next 5 minutes. Unless, of course, they're NPO on dextrose containing IVF.

    There should be policies in your facility and the orders should specify how it is to be given. Dixie is right, "Joe told me it was ok" wouldn't fly if the patient became hypoglycemic because insulin was administered when he did not intend to eat.
  6. Visit  Hygiene Queen profile page
    #4 3
    I don't think the OP wanted to know if she should do it.She wanted to know if anyone ever heard of it.I have not.
  7. Visit  DixieRedHead profile page
    #5 0
    Quote from mappers
    Thanks, but that doesn't really answer the question. No where did I say I would do that. My question was has anyone ever heard of this. I guess your answer is no.
    I guess I DIDN'T get the question. You are quite right. And no I have never heard of it.
    My apologies.
  8. Visit  0402 profile page
    #6 0
    I know that for many of our pts, we do 1/2 of the HS dose, based on it not being given with a meal, but we never 1/2 the FSBG and dose off of that- we use the actual FSBG and 1/2 the SSI dose (and then round up if it comes out to X.5). I have seen this type of HS dosing at more than one hospital.
  9. Visit  joanna73 profile page
    #7 0
    I've never heard that or seen it written anywhere. Follow protocols and use evidence based practice. You need to have a sound rationale for these actions.
  10. Visit  CT Pixie profile page
    #8 0
    I've never heard of anything like that during my short time as an LPN (3 1/2 yrs) nor was it ever mentioned during my schooling. Just texted a few coworkers and they all deny ever hearing anything like that while in school or in their years of practice.
  11. Visit  Esme12 profile page
    #9 0
    What you are asking for is the "correction factor." I have seen this used only with insulin pumps. A correction factor is how much one unit of insulin will drop blood sugar. This number is different for everyone based on how sensitive they are to insulin. This can be calculated to estimate the correction factor by using the 1500 rule. Add up the total daily insulin dose for three days in a row and average the three days, then divide 1500 by the total daily dose. Example: If 30 units of insulin is taken each day (basal and bolus doses) then the correction factor would be 50. One unit will lower blood sugar 50 points. This rule is for regular insulin and there are different rules for Humalog and Novolog. You will add this correction to the meal time dose based on the pre meal blood sugar. You only add insulin to the basal rate when the blood sugar is above the target goal. However, if the blood sugar is very low, you can use the correction to also lower the meal time dose.

    This might explain it better. Bu tlike I said I have only seen this used with insulin pumps.

    Correction Factor |

    Another reference but I have not heard of the conversion you collegue speaks of.
    Last edit by Esme12 on Jan 26, '12
  12. Visit  MN-Nurse profile page
    #10 1
    Glucose swings depend on a heck of a lot more than just what the patient is or isn't eating or what the BG level is at one point in time.
  13. Visit  ShantheRN profile page
    #11 1
    Never heard of it....and I'm a pumper myself. None of the hospitals I've been in as a patient, student, or RN have those rules either. If it's a correction factor/sliding scale, it wouldn't matter if the trays were there since you're only correcting the current BS. It's reasonable to assume patients would want their correction and mealtime dose in the same injection so waiting for trays makes sense (especially if you're using a fast acting insulin.)

    I've been diabetic for more than half my life and I've never heard of this 50% junk. It wouldn't surprise me, considering how diabetic care in a hospital is inadequate for establishing/maintaining control - just my humble opinion, of course Hope this helps!
  14. Visit  CDEWannaBe profile page
    #12 0
    I've had type 1 for over 30 years and have never heard the 50% rule.

    However, in theory it should work. Your co-workers rule is just that if blood sugar is at least 160 (because 80 or above is safe) then insulin can get a headstart before food arrives. The only catch is that the patient would need to eat 15-30 minutes within getting the insulin or it could cause a low.

    Another drawback is if the patient has delayed digestion because the meal is high carb or high fat then it could cause a low.

    Like others have said, stick to giving insulin as ordered.