If you have a 12yr old child on an insulin sliding scale for lunch coverage that MD orders state if bg under 100 give 5units of insulin. If the Childs bg is 60 before lunch and you give a snack and recheck bg=90 do you still give the 5 units or would you with hold the insulin and not cover for lunch?
Sep 17, '12
I'm not real sure.. Are you sure it is for UNDER 100.. I don't do peds but for our adult ICU pts the sliding scale does not come into play unless their BS is over 140... I would clarify the order. While 5 units is not a lot, I would hate to drop them too low if they really didn't eat much. I hope others with more experience chime in for you..
Sep 17, '12
I'm only speaking on this from the perspective of a Insulin Dependent Type 2 that uses Novolog and Lantus.
If my lunch had carbs in it, I would need insulin to cover for that lunch. If my sugar is under 100, I would make sure though that I ate within 15 minutes of injection. My average lunchtime bolus is 15u. I wouldn't go any longer than 15 if I was 100 or under. If I was say 150, I may wait 30 min to an hour.
If there was any reason to suspect child wouldn't eat lunch, I'd definitely withhold.
Sep 18, '12
I would clarify with physician. With Blood sugar at 60, was the child on the way to lunch room to get lunch? I would have used lunch foods if possible to bring it up and skipped the insulin personally. Better a little high than way too low. Has this student's lunch schedule changed from last year? Lunch time is later than year before? I would let MD know of any variables.
Sep 30, '12
Is the child type 1 or type 2?
Oct 2, '12
I would confirm the order. Most pediatric endocrinologists prefer pedi glucose levels to be higher than adults as their brain needs the energy. In the scenario you gave I think it would be dangerous to give Novolog AFTER eating. There are times when fixed doses of rapid acting is needed, and it is generally dosed by weight, not carbs. Again, the order is not clear as stated.
Oct 4, '12
Sliding scale is usually based on weight if the diabetic is on a fixed meal plan and eats the same # of carbs at lunch every day. But most diabetics dose their short acting based on the # of carbs they are eating and current blood sugar.
Like everyone has said, the order sounds off and needs to be confirmed.
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