Carb insulin ratio

[hollierncrrn]

Do you use carb insulin ratios often at your facilities? We are seeing it more and more, and I understand the rational behind it. In theory it sounds good, but the population I work with really struggles to learn it.

I also was wondering what your hospitals protocol is for administering the insulin. Our policy is to obtain the carb count for what the patient is served (based on a menu filled out the day before), and administer novolog insulin based on what the patient is given to eat (not what they actually eat or plan to eat). At another one of our facilities they actually base it on what a pt has eaten or is going to eat (our policy has no provisions for patients who are nauseated or not eating well). I voiced my concern re the potential for hypoglycemic reactions of a patient doesn't eat, or doesn't eat well, but our dietician doesn't see a problem with giving the insulin when a patient doesn't eat (she actually said the difference in protocols is because our patients tend to "eat better" than those in acute care settings). I work in a combined acute rehab/ skilled rehab unit and completely disagree with that statement. What do you do at your facilities?

[classicdame, MSN, EdD]

we stopped it for non-compliance. Now we give a basal insulin (Lantus or Levimir) plus a fixed dose of an analog (Humalog or Novolog) PLUS more analog based on pre-meal blood glucose level. More objective.

The doses are based ADA and AACE recommendations. Look at National Guideline Clearinghouse | Home