I have a question about Insulins....

[Jessmed0324]

Hello everyone:) I hope all is well. I recently praise the Lord got a job at a local nursing home in my home town. They have a little over 50 patients with only one nurse per shift and 4 aides and 1 med aide. My question is that there are i believe 5 patients that are diabetic and have scheduled insulins. One recieves Novolin 70/30 33 units at 4:30 and regular insulin according to the sliding scale. Another patient receives Novolin 8 units and Novolog 12 units at 4:30 and then Lantus at 8:00. 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? For anything under BS of 100 you can hold a scheduled insulin until after lunch right? 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:)

[CABG patch kid, BSN, RN]

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.

There is a doc I work with that often orders "x"units of Novolog before each meal, so a set number regardless of blood sugar isn't odd unless the patient isn't going to eat right afterwards. You would still check the sugar before giving it and hold the insulin if its too low, but I guess what I'm saying is that Novolog isn't just for sliding scale.

[ChristineN, BSN, RN]

There is a doc I work with that often orders "x"units of Novolog before each meal, so a set number regardless of blood sugar isn't odd unless the patient isn't going to eat right afterwards. You would still check the sugar before giving it and hold the insulin if its too low, but I guess what I'm saying is that Novolog isn't just for sliding scale.

Seeing how Novolog is fast acting, makes me wonder how effective it is if you are just getting the same dose all the time. At my facility,, almost all of my patients are on Humalog or Novolog sliding scales, in addition to other insulins.