Insulin Dose Adjustment

[jordangregory]

When covering meals with novalog (regular), do any of you adjust the dose according to how much of the meal the patient eats or will eat?

[dansingrn]

Absolutely. The best way to cover meals is to match the insulin to the amount of carbohydrate that will be eaten. If the patient takes a set dose, then ideally the meal should have a "set" amount of carbohydrate. The standard of care is to dose insulin whenever a meal or snack with carbohydrate is consumed. The dose is based on a ratio of 1 unit to X number of carb grams, the ratio varies among patients. Sounds a little complicated, but is actually very easy if good label-reading/carb gram counting skills are taught effectively.

One of the reasons insulin pumps work so well is that the ratios are programmed into the pump. The patient simply inputs the number of carb grams to be consumed, and the pump calculates and delivers the precise dose to cover the meal, down to one tenth of a unit.

By the way...Novolog and regular do have very different onset, peak and duration times. It is standard to dose Novolog (and Humalog) by a ratio, but not regular.

[classicdame, MSN, EdD]

First off, Novolog is NOT regular insulin. You might have been using the word "regular" in another sense, but that is dangerous as even a tiny dose of Novolog can cause hypoglycemia.

And the dose is dependent on what the MD has ordered. MOST of the time the dose is adjusted per carbs consumed, but I know this is not always the case. There is no one-size-fits-all in diabetic medication dosing. The trick is to do what the MD says and ask him/her for rationales since you will be the one living with the management of the disease.

[*ac*]

You also have to take into account what the premeal fingerstick was.

[dansingrn]

Of course you must follow the written order. I sure didn't mean to imply that as a RN in the hospital you would adjust the dose according to my example. I was just giving an example of the current standard-of-care dosing model - that you might see used by the physician or nurse practitioner writing the order. Sorry if I wasn't clear about that.

As far as Novolog/Humalog/NPH/Lantus/Regular ----all of these insulins have the same

"strength" per unit. One type is not "stronger" than another. They DO however have different onset, peak and duration. For that reason, the timing and amount of the dose is EXTREMELY important. The rapid-acting insulins may seem "stronger" because they have a much much quicker onset than the others. On the other hand, their ability to lower glucose does not last as long as regular, nph and lantus. All of these insulins have different uses depending on the timing and the manner in which the dose is calculated.

Hope that clarifies, and doesn't add to confusion:)