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!

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!

I know it is so different. It is in a school and I work with many disabled childern and this child is highly autistic, no chance he will ever be giving it to himself, but even still it has a high rate for someone to miscalculate because it is so wordy. I would LOVE a sliding scale for him, and yes your right it basically a sliding scale, it is just a roundabout way of getting him there. His last AIC was 5.8 so he is very well controlled so i'm not sure why we have these weird orders, plus his mother will only supply us with a novolog pen that can only be dialed to increments of 1 unit, so in the case of the example I just gave, I would give him 0 insulin. After all that! I guess its just one of these weird things I can put into my experience box. Thanks so much for responding.

I know I hadn't either, that's why its still confusing to me. This is how I have been doing it, I take his BS before eating and his target is 120. If its 120 or less he gets no insulin. If above 120 you do the math to calculate the appropriate amount of insulin to cover the blood sugar. Then you wait until he is finished eating, count the carbs and do the math to calculate coverage for that and add the 2 together. But then there is a "negative" order, meaning if his blood sugar is "50 less than 150" (exact wording) he gets a "negative amount" or as I have been doing it, subtract 1 from the total amount of insulin to be given. So here is an example. BS is 83, so since it is below his target I know he is to get no insulin to cover his BS, and since it is "50 below 100" that the total amount of insulin to be given I should subtract 1 from. So he eats 50 carbs and I do the math (his orders are 1/2 unit per 20 carbs) to get 1.25. So no insulin for target BS, and 1.25 units for carb coverage. Then I subtract 1 for what the orders state as a "negative" order, making him get a total of .25 units of insulin. I believe I am doing it right, and sometimes just writing it down it makes more sense, but I still am unsure. Maybe the term "negative" insulin is not the correct term, and i'm getting hung up by that? Thanks for the response. Marie P LPN =) -

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

Hi all, My name is Marie and I am a LPN for 2+ years. I recently quit a job I have had for the past 2 years because I was working in a Family practice office and my direct supervisor was the Dr's wife and all though I loved working with the Doctor and yes I even liked his wife, she made it very difficult to stay employed there. As a small office of 6 in the past 2 years that I have been employed I have seen 12 people come and go, with myself being the most senior employee in the office. I was suffering from major burn-out do to demands placed upon me and they were ever changing. What would work for me one day, would change the next day. I found myself working lots of overtime (without pay) and being stressed to the max. My problem is this, I am now going on several job interviews and am unsure of how to handle the question, why did you leave your last job. I do not want to "bad" mouth my former employers because 1) I do like them 2) bad mouthing someone just makes me look bad. Any one have any suggestions on how to handle this to make a negative look like a positive? Thanks in advance guys.... Marie