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Diabetes Question

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Keeperofbandages is a CNA, LPN and specializes in School Health.

750 Profile Views; 65 Posts

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?

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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

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Keeperofbandages is a CNA, LPN and specializes in School Health.

65 Posts; 750 Profile Views

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,

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by ARN Member Nurse

ARN specializes in medsurg/school nurse.

67 Posts; 164 Profile Views

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. 

Edited by ARN

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by ARN Member Nurse

ARN specializes in medsurg/school nurse.

67 Posts; 164 Profile Views

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. 

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126 Posts; 834 Profile Views

The first way. 

 

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26 Posts; 512 Profile Views

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.

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bluebonnetrn has 18 years experience as a BSN, RN and specializes in School nurse.

128 Posts; 5,333 Profile Views

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
 

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38 Posts; 958 Profile Views

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

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MHDNURSE has 21 years experience as a BSN, MSN, RN, NP and specializes in Pediatrics, Community, and School Health.

1,388 Posts; 12,969 Profile Views

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.

Edited by MHDNURSE

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mainecoonRN92 has 5 years experience as a BSN, RN and specializes in School Nursing.

30 Posts; 483 Profile Views

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! ^^

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JenTheSchoolRN is a BSN, RN and specializes in School nursing.

2,620 Posts; 24,198 Profile Views

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. 

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