Well, I made my first potentially dangerous screw-up in clinical last night.
Pt is newly dx'd diabetic & receives:
-a regularly scheduled dose 15 units Lispro @ 1700
-sliding scale Lispro once blood sugar hits 150
So, the nurse says to me something to the effect of, "So, what we've been doing is taking his blood sugar, giving him his insulin, then he orders his dinner. Trays take about 30 minutes to come up." (I now know some warning bells should have gone off right there.)
Take the blood sugar - it's 79. I give my standing 15 units Lispro with the nurse, we order the pts supper tray, I sat and shot the bull with him for awhile, then went out to the nurses station to catch up on some paperwork & watch for his tray. While I was going through his chart, my teacher stopped by & asked if I'd given the pt his Lispro, I told her yes & she asked, "And he's eating now?" I said, "We've ordered his tray - it should be here in about 20 minutes." She asked how long ago I'd given the insulin & I said about 20 minutes ago.
Teacher immediately goes into panic, starts running toward my pt's room, asking me what the onset of Lispro is. I babbled like an idiot that I didn't know off-hand, that I knew I should know it, that I think it's 15 minutes, but I'm not sure.
Well, pt's fine (thank God). Teacher tells me to go get him a snack to tide him over until tray comes up. While I'm in the kitchen getting the snack, I run into the nurse & tell her what's going on with my teacher. She kinda laughed it off, like it's no big deal. And it really didn't seem like a big deal - the pt was absolutely fine.
But I know what my drug book says & I understand why my teacher was so upset...what happens in the real world? I'm starting to think a good rule of thumb is to always give insulin with a snack or wait until the tray comes up to give it...is that a good rule? Or do people just give insulin "around" the same time as meals are served?