Max dose for humalog?

Nurses Medications Nursing Q/A

I am new to nursing! I just started my new job and this is my third week. I had a new patient who is overweight and she receives a scheduled 24 units of humalog insulin before meals. I was nervous to give her this much insulin because I've never given this much before and her BG was 134. I went to my supervisor and explained to her my concern and she said to give it anyways. Was I just worried for nothing? Because my supervisor never gave me a clear explanation why it was OK, but said it was ordered.

It's good that you are questioning orders!! Never just give it because it's ordered. This might very well be an appropriate dose for that patient even though it is high and the blood sugar is below 150. What I do in these instances, is I look at their record... What have their blood sugars been and at that time what dose of insulin did they get each time... If they've been 130's or around there ans recieving that much insulin then they can definitely handle it. If not then I might see if their long acting insulin was recently adjusted and now we're seeing better over all coverage and maybe now a decreased need for bolus amount.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Roo.RN said:
What I do in these instances, is I look at their record...

Also, if the patient is alert, oriented times four, and a seemingly good historian, I'll directly ask him/her if it's a usual dose at home. The majority of the time, the answer is yes.

One patient reassured me that she's been on 100+ units of 70/30 BID with breakfast and dinner for many years. She insisted, "Go ahead and give it. It's the only thing that keeps my blood sugars under control."

TheCommuter said:
Also, if the patient is alert, oriented times four, and a seemingly good historian, I'll directly ask him/her if it's a usual dose at home. The majority of the time, the answer is yes.

One patient reassured me that she's been on 100+ units of 70/30 BID with breakfast and dinner for many years. She insisted, "Go ahead and give it. It's the only thing that keeps my blood sugars under control."

This is where I start. If the pt is not oriented or doesn't know I will start digging through the chart and asking people. I always ask the pt first. "They wrote for xyz for your insulin. What do you take at home?"

It's a large amount though so kudos for questioning it.

Or facility recently switched from 20mg vials of dex to 4 mg vials. The first time the pixis told me to pull 5 vials I was like, "wha?? How much was that order for!?!? Oh OK"

Good instincts. Never write off that feeling as nothing. Home it to a sharp edge!

It's not such an unusual dose, as many here have stated. The problem I have with insulin is giving it before the patient actually eats. What if they don't actually eat? Or if they vomit? Or whatever else can go wrong does go wrong?

Kooky Korky said:
It's not such an unusual dose, as many here have stated. The problem I have with insulin is giving it before the patient actually eats. What if they don't actually eat? Or if they vomit? Or whatever else can go wrong does go wrong?

Standard protocol for fast acting insulin like this or Novorapid is 30 minutes before eating - it stops the post-prandial rise where the glucose is in the blood stream, but the insulin hasn't had time to start working. Things go wrong, you fix it - fast acting glucose, whatever you need to do.

I know that here (in NZ) the general rule for Type 1 Diabetics is no more than 1u/kg/day - however there are times when this changes, extreme insulin resistance (metformin is often prescribed), massive hormone changes (puberty), and sickness with ketones. For Type 2 Diabetics - I'm not 100% sure, but I have seen small doses, and I have seen massive doses. It depends on the prescribing physician too - some really have no idea, and just put them on a 30/70 mix 3 times a day because that's all they know.

Specializes in Oncology.
TM84 said:
Standard protocol for fast acting insulin like this or Novorapid is 30 minutes before eating - it stops the post-prandial rise where the glucose is in the blood stream, but the insulin hasn't had time to start working. Things go wrong, you fix it - fast acting glucose, whatever you need to do.

I know that here (in NZ) the general rule for Type 1 Diabetics is no more than 1u/kg/day - however there are times when this changes, extreme insulin resistance (metformin is often prescribed), massive hormone changes (puberty), and sickness with ketones. For Type 2 Diabetics - I'm not 100% sure, but I have seen small doses, and I have seen massive doses. It depends on the prescribing physician too - some really have no idea, and just put them on a 30/70 mix 3 times a day because that's all they know.

30 minutes is good for regular insulin, but it's too far ahead of the meal for rapid insulin if starting with a normal blood sugar. 10-15 minutes before the meal, or even right as they start eating, then.

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