Help with insulin question!! Please!

VickyRN, MSN, DNP, RN · Jul 9, 2006

My preceptor gives me sets of questions to take home and turn in the next day. I simply am not sure of the answer to this one, so if any kind soul can help me out I will surely appreciate it.
-Which is an incorrect order for insulin?
a. 5 units Humulin R subq now
b. 10 units Humulin R subq every AM
c. 30 units Humulin N subq every AM
d. 60 units Humulin R subq now
I think it would be d, bc that seems like way too many units to give to a pt, am I right?

I agree with you - WAY too many units of the fast-acting insulin (onset: 1/2 hour, peak: 1-2 hours, duration: 4 hours). Sure to drop the client's serum glucose precipitously to dangerous low levels. Remember the brain needs two nutrients to survive - oxygen and glucose. Deprivation of either can cause irreversible brain damage or death.

Audreyfay · Jul 9, 2006

I agree with the above - D. If a person needs that much insulin subq NOW - they should have an insulin drip started. I would question that order. The 60 might really be 6.0 units (which is not an approved format to use, but some still forget and use it anyway.)

tatgirl · Jul 10, 2006

I too agree. 60 units is way too much to give. If I saw that order, i would be on the phone asap clarifying it with the doc!

Wendy

chiquiraveloski · Jul 10, 2006

Definitely tooooo much insulin. I have been insulin dependent for 35 years and 60 units is way too much.:nuke:

grambograham · Jul 12, 2006

agreed... answer is D

~Kitty~ · Aug 16, 2006

I am seeking the answer to an almost identical question. I too first thought 60 units of Humulin R ..... whoa!

But then, got to reading into it, thinking about it .....

what about an order for giving Humulin R QAM ... I've generally seen it used as sliding scale coverage, not generally ordered at a set dosage QAM?

and.... I wondered if a patient had an incredibly high blood sugar if they would ever order such a massive dose ...... but I too think that the insulin drip is more likely.

So, what about my question... is Humulin R ever ordered set dose routine?

(Please keep in mind that it is late and a few of my brain cells have probably already started to snooze!)

EricJRN, MSN, RN · Aug 16, 2006

Kitty,

I still think we're talking way too much insulin, even for a sky-high glucose. Most of the sliding scale charts for Humulin R go up to ~25 units and that's at a blood sugar of ~350. Any higher than that, the chart usually says, 'Call doctor.'