Diabetes Question

[Keeperofbandages, LPN]

When doing a diabetic dosage calculation, do you use the correction formula + carb ratio (ex. 2.2 + 4.3 = 6.5 ( 7 units) or do you round the 2.2 (2) + 4.3 (4) = 6 units? I have heard that the first way I showed is the way they are calculating insulin now. How does everyone else calculate?

[ruby_jane, BSN, RN]

I do whatever the orders say. What do the orders say?

[Keeperofbandages, LPN]

4 minutes ago, ruby_jane said:

I do whatever the orders say. What do the orders say?

The DMMP does not say. I am working on getting clarification, but I was wondering if insulin calculations changed since I was always taught to do each calculation separate, round up or down then add the 2 calculations together,

[ARN]

round each number then add together is what my sons orders say...I think....now that we pump and don't calculate as much I am really not 100% sure. we do have a rounding rule that i put in my phone.

00.-.24 round down to whole unit.

0.25-.74 round to 1/2 unit

.75-.99 round up to next whole unit.

since im in the high school setting my students are independent and there isn't anything on their orders about rounding or adding doses together.

[ARN]

I edited my response above. it makes more sense to me to add both together and then round. but i am pretty sure we were taught when we came home from the hospital to round each then add. but I will have to look for that info when I get home. i am 100% sure i now add both and then round once. but thats for my own kid. now you've got me curious how we were originally taught so im going home and digging out papers lol.

[ihavealltheice]

The first way.

[NurseHeatherBSNRN, ASN, BSN]

1 hour ago, Keeperofbandages said:

When doing a diabetic dosage calculation, do you use the correction formula + carb ratio (ex. 2.2 + 4.3 = 6.5 ( 7 units) or do you round the 2.2 (2) + 4.3 (4) = 6 units? I have heard that the first way I showed is the way they are calculating insulin now. How does everyone else calculate?

I've always been instructed to calculate completely first, then round the final answer.

[bluebonnetrn, BSN, RN]

This is what I do:
Calculate carb ratio just based on carbs
Calculate correction dose based on BG level

Add 2 numbers together then round

[arlingtonnurse]

1 minute ago, bluebonnetrn said:

Calculate carb ratio just based on carbs
Calculate correction dose based on BG level

Add 2 numbers together then round

This as well. It will give a more accurate dosage

On 2/3/2020 at 2:33 PM, Keeperofbandages said:

The DMMP does not say. I am working on getting clarification, but I was wondering if insulin calculations changed since I was always taught to do each calculation separate, round up or down then add the 2 calculations together,

The orders for my student specified to calculate each separately, then add them together, then specified to always round that total DOWN.

[mainecoonRN92, BSN, RN]

On 2/3/2020 at 1:12 PM, NurseHeatherBSNRN said:

I've always been instructed to calculate completely first, then round the final answer.

This! ^^

[JenTheSchoolRN, BSN, RN]

19 hours ago, MHDNURSE said:

The orders for my student specified to calculate each separately, then add them together, then specified to always round that total DOWN.

Interesting.

I will say, each kid is different.

I had a kid on a pump, whose pump and orders would calculate with carbs and current BG at lunch 15 unit bolus sometimes.

That 15 unit bolus would ALWAYS given this student a low BG 1.5-2 hours later when the short acting insulin peaked.

So we tweaked (which I could do up to 20% based on school orders) and rounded carbs down a bit. Mom updated and called doctor to report this and we did also get orders tweaked a bit as well at student's next office visit.