Is Humalog also used as a corrective insulin (based on BS) at bedtime ALONG with Lantus?

[Nurse2bnwbie]

I have asked this same question many times to my coworkers but there is never a straight answer. They are concerned about the pt having a hypoglycemic episode overnight since the novolog acts faster, and many times the pt doesn't want to eat something that late at night, so what I have observed by far is the levemir being given but not the corrective dose of novolog for BS in the range of 180's -200's. I'm a new nurse ( still doing the residency) and the most common insulin used on my floor are novolog (sliding scale) ACHS and Levemir (Bedtime) The protocol for sliding scale is if BS >150.

I will also appreciate if someone can address the issue of NPO pt and insulin... to give or not to give ??

Thank you !!

[blondy2061h, MSN, RN]

It depends whether the sliding scale is calibrated to just drop the blood sugar to normal or to drop the blood sugar to normal and account for them eating. The ideal situation is to have the sliding scale just drop the blood sugar to normal then st meal times give an additional amount of the rapid acting to cover the meal. In that case, it makes sense to correct a high blood sugar any time a glucose reading it taken, so long as insulin isn't being stacked (additional insulin being given while a previous dose hasn't worn off yet).

[mmc51264, BSN, MSN, RN]

Lantus is a basal insulin that has nothing at all to do with mealtime or ss insulin. If a BG is 120 or 320, the Lantus does remains the same. The SS amount would be given per order.

Daily insulin requirements, when on Lantus and a short-acting, are weight based with 1/2 being Lantus and the rest divided into 3 mealtime doses. IF blood sugar is higher than goal, sliding scale insulin is then used as a correction. At bedtime, the Lantus would be given and then sliding scale if warranted (our SS starts at BG >200)

[CelticGoddess, BSN, RN]

mmc51264 said:

Lantus is a basal insulin that has nothing at all to do with mealtime or ss insulin. If a BG is 120 or 320, the Lantus does remains the same. The SS amount would be given per order.

Daily insulin requirements, when on Lantus and a short-acting, are weight based with 1/2 being Lantus and the rest divided into 3 mealtime doses. IF blood sugar is higher than goal, sliding scale insulin is then used as a correction. At bedtime, the Lantus would be given and then sliding scale if warranted (our SS starts at BG >200)

Insulin requirements are dependent upon the patient and I don't see how it is weight related. In my case, I am on a very high dose of Lantus (130units daily)due to inhaled and systemic corticosteroids. I split the dose. I also take Humalog before meals and at bedtime as needed.

I am curious where weight comes into this? The only time my weight has come into it was when I was in DKA and was an insulin drip. I typically don' take a prandial dose unless I am in the hospital and taking high doses of steroids. Again, the doses are not weight based.

Really curious about this.

[NewMurse1014]

At my facility, we have two separate ISS for AC (>120) and HS/NPO (>200) and hypoglycemic protocol (

[canoehead, BSN, RN]

If you have a new diabetic you would dose the insulin based on weight. So, a total daily dose, divided into a long acting and three meal time doses. Our insulin orders have low, med and high dose protocols that the docs choose from, so people that are more resistant to insulin get the high dose protocol. Once we get a few days on a consistent protocol then we can start titrating more specifically to individual patients. These are patients that we need to start from scratch with, new diagnosis, or terrible compliance with no baseline. Once people get into the hospital their eating habits can be drastically changed too, and they get hypoglycemic on their home insulin doses.

[TheCommuter, BSN, RN]

Moved to the Nursing & Patient Medications forum.

[mmc51264, BSN, MSN, RN]

Canoehead explained better than I did. Of course, everyone is different as in your case with having doses of steroids. I was discussing, in general, how dosing is calculated.

I am our diabetes "champion" on my unit and getting people to understand the different purposes of a basal insulin versus a short-acting insulin is very important. I even have to educate the residents sometimes about the importance of Lantus. And mealtime insulin even when on an insulin gtt.

I have T2 and 2 children that are T1. I try desperately to get people to understand just a little bit better. OP wanted to know about giving Lantus and Humalog together. I get this question ALL the time and have to reassure people that is is OK, even expected, to give the two.

[wolf9653]

giving the humalog, according to the sliding scale at HS to bring a high BG value into a more acceptable range is pretty common practice. In these cases it isn't being used to cover a meal. Usually meal coverage is standing, and with a sliding scale on top of that to cover a high BG. It's not a bad idea to do a follow up BG an hour or so after giving the humalog if you feel a need. If in doubt, you should call the MD before holding it. generally, whenever you hold a med the MD should be notified. The lantus is generally irrelevant to this.

[brillohead, ADN, RN]

Our facility typically only corrects HS blood glucose if >200 (that's the standard order set in the computer, unless the physician makes changes at the time of ordering.

Some patients have AC coverage per sliding scale and HS coverage only if >200, some have AC coverage per sliding scale with an HS Accucheck only but no insulin ordered (and if they are crazy high at HS, we page the doc for a one-time dose).

Lantus/Levemir would be administered in all cases (unless blood glucose is low to begin with, obviously). The big thing to remember is that while you can give Lantus/Levemir at the same time as fast-acting, you never actually MIX them and administer in one syringe -- separate pokes for long-acting insulin, no matter what!