When to NOT give insulin?

  1. I need some help understanding insulin therapy. Evidently, I need a lot of help. How do I understand the effect of different types of insulin on blood sugar? And how do meals and meal times relate?
    I can't give insulin to a patient if I don't know when to withhold it!
    This will probably be a long answer but I would really appreciate it if someone would take the time.
  2. Visit natrgrrl profile page

    About natrgrrl

    Joined: May '06; Posts: 412; Likes: 108
    from US
    Specialty: LTC


  3. by   MisterSimba
    This may help, at least a little bit


    Is there a children's hospital where you live? I know the one I'm volunteering at has diabetes educators that work with newly diagnosed Type 1 diabetes patients. I'm sure they could answer all of your questions in detail!
  4. by   leslie :-D
    here's another link:

    Understanding Insulin


    once you understand the onset/peak/durations of ea insulin, you will gain a much better understanding on how these correlate w/meals and snacks.

  5. by   miko014
    While it is important to know all the different insulins and times of action, peaks, etc, you should also listen to the pt. Many of the pts who will need insulin will have been taking insulin for a long time and will know their own body. Some people have huge drops in blood sugar at night, and so will not want to take insulin at night. For example, I had a pt the other day who had a blood sugar of 152, and according to her SSI, she was to get 4 units of regular. She didn't want to take it because sometimes her sugar goes into the 40s over night. I didn't argue with her, and sure enough, even without the insulin, she was 64 in the am. Had I given her the insulin, she may have dropped way lower and had problems. It doesn't feel good to have your sugar too low! Then some people are more sensitive to insulin than others are, so moral of the story, if your pt is lucid, allow them input into their care!

    Of course, if her sugar had been 400, I would have argued a bit more about letting me give her the insulin!!!

    You should find a chart you like and carry it with you. I'll look around for mine and post it later if I can find it.
  6. by   lsyorke
    Quote from miko014
    While it is important to know all the different insulins and times of action, peaks, etc, you should also listen to the pt.
    Key point! Listen to your patient. Hubby constantly battles nurses when he's admitted on his insulin regiman. It's gotten to the point now that they endocrinologist just writes, "patient may take own insulin on his own schedule".
    Regardless of documented peak action times, some patients have very individual reactions to insulin.
  7. by   natrgrrl
    I'd like to see what chart you are talking about.

    Thanks for all the input.
  8. by   Thornbird
    Most patients with insulin orders will have parameters specified, especially for sliding scale. More and more orders I see say not to give any sliding scale insulins after suppertime because of the likelihood of "bottoming out" before AM.
  9. by   miko014
    I found a paper copy of my chart, but I can't find one online. I tried to type it out but it didn't look right - let me keep looking!
  10. by   miko014
    Okay so I can't edit - here are links to a few charts. None of them is the same as mine, but they aren't bad. I wish I could find one with a graph of action times, but I can't! Also remember to take oral antidiabetic meds into consideration - especially if the pt is NPO.



    this isn't the best, but it may help a little: http://www.endotext.org/Diabetes/dia...es/figure7.png

    Sorry, I can't find the good chart! I hope these help!
  11. by   classicdame
    You do not hold long-acting even if patient is NPO (Lantus/Levimir). This is a basal insulin and the patient requires it even when not eating.

    Do not give the rapid acting insulins to KEEP blood sugar down, only to get it down rapidly or to cover the carbs in a meal. (Apidra, Humalog and Novalog). I had to ask an MD recently to re-write an order because he was using Humalog like regular insulin.

    When in doubt, ASK. Also, ask the Educator in your facility to prepare a good chart, or copy one from online, then laminate and put in each nursing station or medicine room. That alone can make a huge difference.

    BTW, sliding scale using regular insulin is "ineffective and not recommended" per ADA and AACE but many docs are still writing them. Insulin is the #1 med error drug. You are right to be proactive.
  12. by   natrgrrl
    Thanks everyone for giving me the info and advice. I spend 2 full days learning and studying insulin and the PO antidiabetics. I feel so much more comfortable with them now.

    Miko, the link to the graph is one I am going to spend some time figuring out. Thanks.
  13. by   vashtee
    Quote from classicdame
    BTW, sliding scale using regular insulin is "ineffective and not recommended" per ADA and AACE but many docs are still writing them.
    Do you know why this is considered ineffective? Is it because of the length of duration? Should rapid-acting be used instead?

    (Sorry, I am obviously a student, and I tried researching this a bit on the net, but was unsuccessful.
  14. by   talaxandra
    Sliding scales of regular aka short-acting - kicks in quickly and wears off (relatively) quickly, only treat short-term elevation and contribute to fluctuations in blood glucose levels. In patients who are acutely ill or exceptionally brittle they can be the best way (short of an actrapid infusion) to manage swinging or unstable diabetes, but are not appropriate in the longer term.

    More commonly used now are standing orders for long acting or combined insulins, with a salvage scale to top up in the event that the blood sugar is elevated beyond what the usual insulin can manage.

    This is good if the increase is a short term thing - less exercise than usual, new steroids, a 'naughty' snack. If the usual insulin regime is consistently ineffective (ie the salvage scale is being used frequently), then the standing order should be increased.

    Hope that's not all clear as mud!