Insulin Sliding Scales

[CyndiW35055]

Okay, here is the question and I really need help on this.

Doctor's order: AM dose: Humulin NPH 15 units and Humulin regular 5 units SC. The AM blood sugar is 230. How much total insulin should be given?

Blood Sugar Regular Insulin

0-180 0 units

180-200 2 units

200-220 4 units

220-240 6 units

>240 Call Physician

The reason I am asking is that we don't technically have a Pharm instructor. We had someone thrown in to teach the class that has never taught before and so everyone is pretty much trying to help each other. On top of everything else, she told us she is dyslexic so we have alot of fun trying to review our notes after her classes. Personally I think the patient would get the regular dosage of 15 U and 5 U, but do I have to take the sliding scale into account or not at this regularly scheduled time or recheck in a couple of hours and if the levels are still up then use the sliding scale?

[MikeLPN]

NPH 15 units. R 11 units. But only after a recheck before. And a follow-up would be nice.

[MimiK]

I agree with the above, the sliding scale is in addition to the scheduled. Also maybe you just copied the scale wrong but what would you give for a sugar of 180, 200, 220? I have had doctors enter sliding scale that way and Murphy's law says that my patients blood sugar will also be one of those numbers that can fit in more than one category.

The sliding scale at the nursing home where I'm currently in clinicals starts at 201. So, you know definitely that a 200 does not get more. I had a patient last week with a sugar of 230 and standing order (notice I said "standing" and not "regular") for 5 units regular insulin + sliding scale of 2 units regular insulin (BS between 201 and 250), so I gave a total of 7 units regular insulin. My preceptor was a little confused, but I assured her it is what we were taught in Nursing Pharmacology.

Calling the doc is not required in this case when the sliding scale you are using specifies to not call the doc until the sugar is much higher. Such calls could put you in disfavor. Also, re-checking BS more often that indicated in the patient's chart could put you in disfavor, too, with the doc, your supervisor, and the patient. Of course, we are talking about an asymptomatic patient here. Definitely show concern if the patient shows signs of an acute episode. You would want to get aggressive with patient care in that instance.