The other night I had patients who were ordered an outrageously high dosage of insulin for mealtimes plus sliding scale coverage. 100 units and 75 units of humalin R for each patient. Is this legitamite- has anyone ever given this much insulin before?
I ended up not giving the insulin. And on one of the patients, I got the md to dc the mealtime coverage.
But geez, even in a type 1 diabetic, I would think you'd kill the patient with that much insulin...
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
I had a guy once whose regular Lantus dose required TWO injections from the pen, because it didn't spin up that high. It was a while ago, but it seems like his regular dose was 140 units BID, and the pen only went up to about 80 units, so I had to give him 70 units twice.
If presented with a dose that seems off, I would first check to see what their glucose levels have been running and what doses they have been receiving while in the hospital. And if the patient is alert and oriented, I'd also ask what dose they normally take.
Specializes in orthopedic/trauma, Informatics, diabetes.
I have seen T2 patients that are so resistant, they are on U-500 insulin. It is possible to take that much insulin. Agree with PP about the diff between T1 and T2. The T2s are going to be more resistant, thus the higher doses. Just watch BG. If you hold a dose just because you haven't seen that dose before and your pt ends up with BG in the 500s and on their was to the T2 equivalent of DKA and/or on an insulin gtt, that's on you. Look at pts home regimen, ask them, look at trends.
Pregnant Type 1 Diabetics at the height of insulin resistance in their pregnancy may hit ratios of 1 unit of insulin to 1g carb. So eating a meal with 75g carbs would required 75units of insulin.
I'm a Type 2 Diabetic with high insulin resistance. I take Levemir 50 units in the morning and 30 units at night, as well as 45 units of Humalog TID. Sometimes if my sugars are really outrageous, I have to take more insulin in addition to this. I recently started taking Trulicity, though, and it is helping to get my sugars down to an acceptable level, so I find that I'm needing to decrease my insulin doses.
brillohead, ADN, RN
1,781 Posts
I had a guy once whose regular Lantus dose required TWO injections from the pen, because it didn't spin up that high. It was a while ago, but it seems like his regular dose was 140 units BID, and the pen only went up to about 80 units, so I had to give him 70 units twice.
If presented with a dose that seems off, I would first check to see what their glucose levels have been running and what doses they have been receiving while in the hospital. And if the patient is alert and oriented, I'd also ask what dose they normally take.