insulin

Pt has NPH insulin for basal coverage and Novolog per sliding scale . He is NPO for surgery. Last BG level requires 4 U of Novolog. Question:

- Shall I give 4 U Novolog and scheduled NPH ?

Thank you.

Do you have specific orders to hold, or give the dose? I'd get specific orders from the doc doing the surgery. :) With NPO, and going to surgery, I wouldn't give/hold without the specific order.

Thank you for your input! It does make sense to ask the doc to write specific order regarding give/hold insulin to this pt.

BTW, NPH is not basal insulin. It is REGULAR insulin with protamine added to slow down the action, but it peaks. Basal insulin does not peak.

I am glad you questioned the order. Too often I see insulin held completely and the patient's glucose rises to dangerous levels peri/post-op. Sometimes fluids can stabilize during surgery and sometimes not. Check your immediate post-op patient's last glucose level. You might need an order to resume insulin ASAP, not tomorrow when the surgeon makes rounds.

BTW, NPH is not basal insulin. It is REGULAR insulin with protamine added to slow down the action, but it peaks. Basal insulin does not peak.

I don't mean to be disrespectful, but you're confusing apples with oranges. Basal insulin just means it's the base rate of insulin needed to maintain blood sugars when no food is ingested. It can be supplied by any type of insulin (rapid acting, short acting, intermediate, long acting, or mixed).

For example I use an insulin pump which gives only rapid acting Humalog insulin to provide my basal and bolus rates. My basal rate varies throughout the day, just like a non-diabetics, and peaks in the early morning hours when I have dawn phenomenon.

that is true for pumps only. Please refer to standards per ADA and Guidelines.gov

Sorry, but that's not accurate. Both the ADA and Guidelines.gov define basal and bolus insulin as I described above.

The insulin pump is just another way of delivering the insulin. You can give basal/bolus insulin with shots. In effect, a non-diabetic's pancreas secretes basal and bolus insulin.