All about insulin

Can anyone please comment instead of just viewing. Thanks

Giving the levimir instead of the sliding scale coverage was a med error. Was the doctor called to adjust the 9pm dose to the 15 units? why not? What was the 9pm reading? They didn't get coverage for the 4:30pm reading. The doc probably would have just ordered the 15 units and to continue with the regular sliding scale coverage.

bottom line..orders were not followed, a med error occured, nurse was practicing medicine by not giving what the doctor ordered.

The med error needs to be documented via whatever system your facility uses to track incident reports. Then you would need to call the physician with an updated blood sugar reading at 9 pm and explain the situation to get an okay before giving a reduced dose of Levimir.

1). It is a med error. Incident report, doctor to be called, etc. as per local policy.

2). Levemir has no peak, and 5 units is a tiny dose. 95% possibility that nothing will happen. Doc may decrease evening dose of Levemir, although it is not necessary. Nocturnal T-feed will protect against hypoglycemia.

3). Out of abundance of precautions, check CBG at 2 AM. That time will be lowest point caused by SECOND Levemir which would "catch the tail" of the FIRST Levemir before the natural cortisol surge (remember Somogyi effect). If hypoglycemia is going to happen, it will happen around that time. But, again, chances for this are slim to none.