Negative Insulin orders

[mpollos]

Hi all,

I recently started taking care of a 12 year old type 1 diabetic. My question is does anybody have any experience with calculating negative insulin orders? They are a bit confusing and I want to make sure I have a good grasp on it, as of right now I am still walking through the steps with the person training me so I know i'm doing it right, but I still am a little foggy and could use extra help.

Thanks for your help!

Marie P LPN

[truern]

This is kinda what I was thinking you were refering to. Sounds like you are doing it the right way- our orders are worded a little different though- there is no "negative" amount.... more like the example #3 you posted above. I am wondering why you wait until after the meal to calculate and give the dose? We teach them to check the sugar, calculate what they are going to eat, and draw up the dose and give it- THEN eat. I am also wondering why no insulin pump? Most kids are on one unless they prove noncompliant- sure would make your job alot easier:D!! I agree, it is so hard to get used to and I also worry that I didn't calculate correctly... we double check our calculations with another RN with EACH dose(and also the kid/parent) so that mistakes don't happen. Sounds like you are right on the money!

We have ONE doc at work that uses this method...the rest use SSI. We give the insulin after eating because something could happen to prevent them from eating what they've said they would...nausea, visitors, you name it.

I use the method myself...insulin to correct my actual BG plus some to cover carbs.

[mpollos]

wow that was a great example and really seemed to help a lot. I tried searching the web some but was unable to come up with

much. Thanks so much for the reply, and with everyone's help I think I am understanding it right. Have a great day!

[mpollos]

Yeah, the reason we wait until after he eats is because he is so autistic and the amount of food he eats is never predictable. Sometimes he eats everything and wants seconds, and sometimes he spits it out. So basically we have to treat him like a toddler and adjust for what is actually taken in. As of right now there are 2 of us calculating the insulin, but in a few weeks, I will be the only nurse available at the school, although I can always call my supervisor and double check if needed. As far as him not having a pump, I don't know if it has to do with the fact that he is sometimes very destructive do to his autisim, and maybe they are afraid he will discard the pump itself?? He is a good boy for the most part, but at times can be a challenge. Thanks so much for everyones replies, it is very helpful, and comforting to know that I always have a "back up" of people who have similar experiences that I can learn from. Have a great day!

[zacarias, ASN, RN]

What the OP said about sliding scale is true. It is obsolete and not helpful in any way to patients.

This new post-prandial method is good because it takes into account how much food is ingested in addition to the premeal blood sugar. The goal is to decrease drastic highs and lows.

Zman