I have a question about Insulins....

luvmy2angels · Feb 17, 2009

You will hardly ever hold Lantus at night due to it being long acting. You also don't ever want to mix Lantus with any other insulin. You can usually mix the short and intermediate insulins together, just remeber "clear before cloudy". There should be specific orders for each patients as when to hold the insulin as everyone is different. If i would do an accucheck and it was below 60 i would call the Dr for an order to hold the insulin. But then again that was the policy of the LTC facility that i worked in, you may not have to do that. Good Luck, it seems scary at first but you'll get the hang of it!!

Virgo_RN, BSN, RN · Feb 17, 2009

We don't mix 70/30 or Lantus.

blondy2061h, MSN, RN · Feb 17, 2009

70/30 can be mixed with regular. Lantus can't be mixed with anything.

I really recommend you brush up on your understanding of insulin actions and uses and such. You probably shouldn't be holding a scheduled dose for a bg under 100, but it depends on the type of insulin.

ChristineN, BSN, RN · Feb 17, 2009

Another patient receives Novolin 8 units and Novolog 12 units at 4:30 and then Lantus at 8:00.

To me, the Novolog is ordered very unusually. Novolog is very fast acting (ie starts working within 20 min, out of the system within 4 hours), so I all ways have seen Novolog ordered as a sliding scale. Having only one dose regardless of blood sugar is very strange.

Which insulins can you mix together out of the common insulins that you may see on a daily basis and when would you not give a scheduled insulin?

You can mix Novolog (or Humalog, same thing, different brands) and 70/30. You can not mix Lantus. Some patient's mix Levimir and Regular or Novolog, but it is not reccommended by the FDA.

For anything under BS of 100 you can hold a scheduled insulin until after lunch right?

We generally hold for less than 130, but it depends on what sort of insulin the patient would get, and if they are going to eat. Especially if the patient is carb counting, they need to be covered for the meal.

What are the guidelines for holding insulins that are given at night? I am a little freaked seeing as how I am in charge of 50 plus patients on my own....:-/ Any advice is much appreciated:)

I would not hold Lantus or Levimir at bedtime.

Virgo_RN, BSN, RN · Feb 17, 2009

http://www.globalrph.com/insulin_mixing.htm

http://www.globalrph.com/insulin_tables.htm

~MIA~, ASN, RN · Feb 17, 2009

All of the orders should be on the insulin sheets in the MAR.

blondy2061h, MSN, RN · Feb 17, 2009

All of the orders should be on the insulin sheets in the MAR.

I've never heard of an "insulin sheet," but just because something is ordered doesn't mean the nurse should just give it. That's what nurses have a college degree in nursing, versus just some 2 day orientation. It's always the nurses's responsibility to think about what she or he is giving, why, if the dose is safe, and if the circumstances are safe.

bluescrubbss · Feb 17, 2009

Read your labels, it clearly states on the lantus bottle "do not mix with other insulins". As a new nurse working on your own you should always refer to your resources, keep them readily available. If you read your nursing school book on drug administration it tells you clearly that you can mix 70/30 and Regular insulin and how to mix them properly. As for when to hold insulin, what does your M.D. orders say? There should be parameters with all bloodsugar orders, if not, call the M.D. and get some or have him clarify them. You should also know your facilities protocal on bloodsugars. Know your facilities policies and procedures, read them yourself, they differ from one facility to the next. As a new nurse you have no business being the only nurse on the floor taking care of 50 patients. My advice would be to work on a medical surgical floor in an hospital for at least a year before working in a nursing home. At all times you want to protect your patients as well as your license.:bowingpur

Little Panda RN, ASN, RN · Feb 17, 2009

I whole heartedly agree with the poster before me. We have to use our judgement at times when it comes to insulin.

I had this scenario today at work. I had a resident whose BS was 56 at supper. He was scheduled to get 30 units of 75/25. The resident has been sick with an intestinal bug, on a liquid diet of chicken broth and gatoraide, but also getting some saltines with the broth. With a BS of 56 I held the insulin, gave the resident OJ and had him eat his broth and crackers. I rechecked 20 minutes later and his was at 159.

Well you would think not to bad, but my mind goes into hyperdrive and I start thinking about how he has in the past been in the 40's in the mornings and we have had to call 911 to come administer glucose (we are a basic care facility and we dont keep it on hand, why I dont know). Anyways I could just invision this happening again (it has happened twice) so I contacted the doctor on call and he said to administer only 15 units. After I gave him the 15 units, I checked BS at bedtime and it was only 156, so needless to say he would have been very low in the morning if I had given him the full 30.

When in doubt hold and call the doctor.

Virgo_RN, BSN, RN · Feb 17, 2009

Do not mix NovoLog® Mix 70/30 with any other insulin product.

http://www.novomedlink.com/products/NovoLogMix/novologmix-home.aspx

This is why we do not mix 70/30. The manufacturer recommends against it as does our pharmacist.

bluescrubbss · Feb 17, 2009

I stand corrected. But as I said before, read your labels, use your resources.