Insulin regimen - ever so confusing

deftonez188 · Mar 6, 2009

Well I refined my previous search on the site and found a diabetes educator that pretty much answered my above question, i'm going to quote them in case anyone else was interested in learning, from myxel67 site member "Just make sure you read about each type of insulin in your med book or a PDR. Never give a med you don't understand.

Humalog and Novolog are both fast acting insulin analogs, but they are not the same. Humalog (lispro) lasts for a slightly shorter time. Novolog (aspart) has a slightly longer tail and stays in the system about 30 minutes longer. Either is normally given 5 to 15 minutes before a meal. However, if the pt has a BG of 200 or higher, the insulin may be given earlier to give it time to start working. Even though the plasma peak is in 45 minutes to an hour, the pt generally won't feel the full physiologic effect of the insulin for 2.5 to 3 hours--this is when the risk for low BG is highest. You may see or hear of another insulin analog--Apidra (glulising). Their pitch is that it can be given up to 20 minutes after start of a meal.

Usually a hospital will have one or the other on its formulary and will give the nonformulary only if the doc specifies "medically necessary." However, if a pt takes a prescription for Humalog to a pharmacy, the pharmacist must dispense Humalog.

Many nurses (and doctors too) are afraid of insulin and choose to hold (or under-prescribe) much too often. If a pt is about to eat & has a BG of 50, you still should not hold the insulin. Recommended procedure in this case would be to start the meal with a fast acting carbohydrate, and give the insulin in the middle or at the end of the meal.

Many nurses also have problems with Lantus as well. Lantus is a nearly peakless insulin that generally lasts 24 hours. It provides basal insulin only and does not provide any coverage for meals. Therefore, you would not hold if pt is NPO. This is especially important if pt is a true type 1 diabetic (not just a type 2 who has reached the point that he/she now requires insulin.) Since a person with type 1 DM produces no insulin, holding the Lantus (or Levemir, or NPH) can cause a dangerous increase in BG and put the pt at risk for DKA. If pt is on NPH, which has a pronounced peak, the dose might be decreased.

Remember that food is only one source of carbohydrate that will raise blood glucose. The liver also releases glucose into the bloodstream--especially if person skips meal (NPO). You might notice that some of your pts who are NPO continue to have high BG. Sliding scale insulin is intended to lower BG from a high level. It is not intended to cover the meal. Therefore, fast acting sliding scale insulin should not be held if pt is NPO. You would hold any scheduled mealtime insulin though. Ideally, the pt should have long-acting insulin )for basal needs), scheduled fast acting insulin to cover the meal, and sliding scale to correct a high BG.

Watch your pts who have only sliding scale insulin. If they have a fairly good fasting BG (say, 120, which is below the level of the SS) no insulin is given with breakfast. Usually, the ac lunch BG will be well over 200. The pt needs schedule pre-meal insulin to have a chance at getting good control in the hospital."

Daytonite, BSN, RN · Mar 6, 2009

With SSC you are trying to keep the blood sugar at as normal a level as possible. Think of SSC as a little booster to bring blood sugar to within a normal range when NPH needs some immediate help.