Insulin Dosages

I have never given insulin based on weight. I have also seen pts on long acting twice a day and upwards of 120 units at bedtime. Dosage and frequency will vary from pt to pt depending on their needs.

If this is a lesson, clarify the information with your instructor if your book is of little help.

Rarely have I seen this sort of insulin regimen with standing doses used. Mostly I've seen it used for people who need a simple regimen that involves little math. When it's used, it's a TID regimen with mixed Humalog/NPH at breakfast, Humalog at dinner and NPH at bedtime. NPH can be given more than once a day, as you can see with this regimen it is given twice.

10 units is a very small dose of Lantus. I've seen children/teenagers on doses of 50-65 units. Lantus is long-acting/provides 24 hour coverage which is why it is given less frequently.

There are different peaks and duration depending on the insulin type. RA insulin peaks between 60 - 90 minutes and lasts for 3 - 4 hours. SA insulin peaks between 2 - 3 hrs and lasts 3 - 6 hrs. NPH (peaks between 4 - 10 hrs and lasts 10 - 16 hrs) and LA insulin (peakless and lasts 24+ hrs); so yes NPH and LA are meant to last long with only one injection. (Disclaimer: peaks and duration vary from one nursing book to the next)

Where I work the patient's orders have the dose included. We just give what is ordered, no math needed.Wouldn't most patient's have orders that state the dose?

For the children I work with there is a lot of carb counting and correction factors. They are usually on a basal/bolus insulin regimen with orders typically like this: "Give 1 unit insulin for every 50 mg/dL blood glucose is above goal of 150 mg/dL" and "give 1 unit insulin for every 15g CHO to be consumed." Then they're on standing lantus at night. The kids I've seen on TID insulin regimens with standing doses of Humalog and NPH were on it because the medical team didn't think the family could manage the regimen described above. If they're on a pump the pump can do the math, but I've never seen an Endocrinologist offer a pump at diagnosis... they usually make them wait 6 months to a year.

I haven't seen a sliding scale in ages.

I know Peds is different in how they deal with insulin. I once had a ped pt in the adult ICU 17 year old and her insulin orders were very different from what I was used too in the adult world LOL.. I called PICU several times that night..We use SS for meals, no carb counting and lantus at night per order (10-120 units) depending on the pt for our adults.

I have seen carb counting a few times, but mostly it is sliding scale and never by weight.

Okay, from my understanding of what my school instructed us to memorize, is regular/rapid insulin normal dosage is 0.5-1 units/kg/day and should be split into 3 doses.

For intermediate (NPH) it is the same- 0.5-1unit/kg/day. But how come you can only give NPH once a day (I think I heard this right).

Long-lasting insulin is 0.1-0.2 units/kg/day but it is only given once as well per day OR 10 units once or twice a day.

How come long-lasting and NPH is given only once?? Is it because the duration in the body is longer?? Trying to make some sense of all this.

The goal with diabetics is to keep glucose levels in the body within a certain range (not to high and not to low). This is done with insulin products, since it lowers blood sugar. Each insalin has a different onsets, peak and durations. Usually, you have a longer lasting insulin such as Lantus (long acting) that maintain a basil amount of insulin and a shorter acting insulin such as lispro (rapid acting)that controls spikes in glucose after a meal. .