insulin tx.

[missmar]

Patient taking NPH and Regular insulin before breakfast and dinner. Would you increase or decrease Regular insulin or NPH insulin if at 6pm patient is hyperglycemic?

[Rob72, ASN, RN]

What are the FSBS values?

Here's what you're looking at:

1) NPH is the baseline, it should not change much, except for times when the pt is increasing carb intake, or if the pt will be more/less active throughout the day.

2) Reg is the short action. If you know a carb-insulin ratio for the pt, it should be fairly accurate, again, you have to consider changes in activity and intake level when considering this.

If intake is fairly stable, but the pt is significantly less active than at home (i.e., the hospitalization), and if FSBS levels are high pre and post prandial, you most likely want to increase the NPH, in accordance with doc's orders.

If 2* post-prandial sugars are high, you'll need some correction with the Regular with each meal. If the waking FSBS is high (and you're reasonably confident they aren't having the pre-dawn-drop), you look more at the baseline NPH.

Generally, people play with the short-acting because it requires less monitoring, and my suspicion is that will be what will be ordered. This is convenient for staff, not so much for the patient. Most patients(or caregivers) are not agressive enough to really work their baselines, nor are many informed enough to really balance things tightly anyway...

NPH adjustment is generally something to do over a 3-10 days or longer, in practical terms.

Edit: I am speaking as a 30-odd year diabetic, more than a floor-RN.

[missmar]

Thanks Rob, You were so right. The doctor finally called back and he said essentially the same thing. My patient is great and very conscientious. We increased the Regular insulin and now have her monitoring her baselines. My specialty is NOT in diabetes so I really appreciated your feedback.