diabetic orders question

[sweetieann]

Have a patient who is carb counting to determine bolus for meals. Their order is 1 unit insulin for every 60 grams carbs. Just wondering your gut reastion to this: Pt gets 45 units carbs. Do you give 0 units insulin to cover (because it's not 60 grams) or do you give .75 units to cover the 45 grams? What do you think the answer would be? I would say give .75 units to cover meal (even though it won't make THAT much of a difference.) Some nurses were giving zero, some were giving the fraction, DR ended up saying to give f:cool:raction to cover.

THANKS!:typing

[blondy2061h, MSN, RN]

I'm diabetic, and used to have a carb ratio similar to that. I needed to get the insulin, even if it was a fraction, or I went high later. Fractional units are hard to draw up, though (and anything in between 1/2 units pretty much impossible), unless you're using an insulin pump (a God send) or diluted insulin (pretty uncommon these days).

What I used to do most commonly was drink some juice or something to push me up to 60 grams so I could take the full unit.

[sweetieann]

I should mention, this patient has a pump, so easy to program it in :)Thanks for your input, it's especially helpful since you yourself are a diabetic!

[Magsulfate, BSN, RN]

Well, since it's easy to program it into the pump, then yes, I'd go ahead and do the fraction. Because this seems like a brittle diabetic, since they have a pump they are more than likely,,, and because they are so serious about keeping their diabetes under control,, I would still give the insulin even if it is just a fraction.

[blondy2061h, MSN, RN]

I should mention, this patient has a pump, so easy to program it in :)Thanks for your input, it's especially helpful since you yourself are a diabetic!

Oh yeah, with the pump the 3/4s of a unit should definitely be given then. The pump probably even had a bolus calculator that can calculate all this if you just enter the carbs and bg.

[blondy2061h, MSN, RN]

Well, since it's easy to program it into the pump, then yes, I'd go ahead and do the fraction. Because this seems like a brittle diabetic, since they have a pump they are more than likely,,, and because they are so serious about keeping their diabetes under control,, I would still give the insulin even if it is just a fraction.

Pumps are wonderful and used more and more often with all kinds of patients, not just "brittle" people, though that term is going out of fashion. I routinely take fractional units, even like 0.15 units to bring down a 125. My control is definitely better for it and my a1cs reflect it.

[Lexxie, LPN]

So are fractional units only used with the pump? I've never heard of drawing up a fraction of a unit via a syringe.

[sweetieann]

we're given things like 3.5 units, etc. Never something like 3.25 or anything in a syringe, but I've seen orders for 1/2 units. Could depend on how fragile a diabetic the patient is.

[EarthChild1130]

I'm torn on it...at first I said 'No way, that needs further clarification before any meds are given'...and then I thought 'Well the order says 1 unit for every 60 grams, so you can fractionate it yourself, and no need for clarification'...and so now I'm just not sure! LOL

Now I'm wondering how on Earth you get half a unit of insulin out of a syringe...wouldn't most of it end up in the needle?:smiley_ab

[blondy2061h, MSN, RN]

Fractional units are almost impossible in a syringe. They do make 30 unit syringes that have half unit markings, but I've never seen them in a hospital. If you draw up insulin (or any drug) in the same syringe you inject it with the same amount will get caught in the needle on the way in and out, so it won't just all stay in the needle. My pump can give bolus doses in 0.05 unit increments.