Give regular insulin 30 units every am?

[Blackcat99]

I saw this routine insulin order at my LTC for the night shift to give at 6am. There is no parameters as to when to hold the insulin. It's just the routine insulin order for night shift to give at 6am. Breakfast trays arrive at 8am. Do you see orders like that very often? The night nurse said his blood sugar was 70 at 6am.

[BuckyBadgerRN, ASN, RN]

Is it Lantus or Levemir that is long lasting, or something that is considered rapid or intermediate acting? We have no parameters for holding---if the sugar is low and we can't raise it, a call to the MD is the only way to hold the insulin. We have a resident that gets over 100u no matter what her BS is...

[Blackcat99]

The nurse who asked me what she should do was a new grad. I told her if it was Lantus or Levemir it would be OK to give it. However, I told her I would not give regular insulin 30 units for a accucheck of 70. She did not give it.

[Esme12, ASN, BSN, RN]

Routine 30 units of regular every AM? I wouldn't give it... I'd call the MD for clarification. FSBS is 70? Nope I wouldn't give it.

[HappyWife77, BSN, RN]

That has to be a long acting insulin. Reread it. No way would you even give coverage for a sugar of 70 with regular.

[Blackcat99]

I re-read the order several times. It does in fact say "Regular insulin 30 units daily"

[chrisrn24]

I would ask for hold parameters. "Hold if BG

[HappyWife77, BSN, RN]

It is possible it was transcribed wrong. Call the Doc/NP.

[Blackcat99]

I am surprised that the admission nurse didn't question that order upon admission. The new nurse said she asked the day nurse to call the doctor about the order but the nurse didn't.

[SHGR, MSN, RN, CNS]

Basal insulins can in fact be given any time of day (same time every day of course) and many people on large doses split the dose by 12 hours. HS timing is just based on tradition and timing of NPH in the past. So just because it is 6am doesn't mean that the order wasn't supposed to be Lantus or Levemir.

[AtomicWoman]

The nurse who asked me what she should do was a new grad. I told her if it was Lantus or Levemir it would be OK to give it. However, I told her I would not give regular insulin 30 units for a accucheck of 70. She did not give it.

I would hold it, too. BG of 70 and you're supposed to give 30 units of regular insulin 2 hours before breakfast? That patient will crash HARD. That new nurse is thinking critically. :)

[SHGR, MSN, RN, CNS]

Critical thinking is looking at the patient over time. Having the doc adjust the dose, the timing. People with Type one are insulin dependent- they will need insulin with a meal even if they are low before the meal.

It's not an "all or none" proposition. Often the regimen needs subtle adjustments. Simply holding a dose does a disservice to the patient.