Question regarding insulin administration

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Specializes in Med/Surg/Tele/Onc.

Another nurse told me something the other day that I have never heard before. I tried googling it and couldn't find anything either. He said that if you are giving insulin and you aren't sure when the pt will be eating, you can divide the BS by 50% and if it is still in a save range, you can give the insulin. He says it should never drop the sugar more than 20 - 25%, but he uses 50% to be safe. So what he is saying is that if the BS is 200 and you give the ordered SS dose, the sugar would at most drop to 100 which is still safe for the pt.

Has anyone ever heard this before??? I was always taught to wait until trays are on the floor.

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Specializes in ED/ICU/TELEMETRY/LTC.

Give the insulin as ordered and per protocol. What "someone told me" ain't gonna fly in court.

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Specializes in Med/Surg/Tele/Onc.
Give the insulin as ordered and per protocol. What "someone told me" ain't gonna fly in court.

Thanks, but that doesn't really answer the question. No where did I say I would do that. My question was has anyone ever heard of this. I guess your answer is no.

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Specializes in Pedi.

The patient's sliding scale is designed to keep their glucose within a certain range. I rarely take care of diabetics and when I do, it's almost always type I (pediatrics) but all of the patients I see have sliding scales based on what the endocrinologist wants their glucose to be as well as carb correction factors. If it's a pre-meal check, why wouldn't you just wait until the food comes and give the insulin immediately prior to the meal? You need to know how many carbs they're about to consume to calculate the proper dosage anyway, if you're also carb-correcting. I know at my institution, if regular insulin is administered, it is expected that the patient is going to be eating within the next 5 minutes. Unless, of course, they're NPO on dextrose containing IVF.

There should be policies in your facility and the orders should specify how it is to be given. Dixie is right, "Joe told me it was ok" wouldn't fly if the patient became hypoglycemic because insulin was administered when he did not intend to eat.

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I don't think the OP wanted to know if she should do it.She wanted to know if anyone ever heard of it.I have not.

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Specializes in ED/ICU/TELEMETRY/LTC.
Thanks, but that doesn't really answer the question. No where did I say I would do that. My question was has anyone ever heard of this. I guess your answer is no.

I guess I DIDN'T get the question. You are quite right. And no I have never heard of it.

My apologies.

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I know that for many of our pts, we do 1/2 of the HS dose, based on it not being given with a meal, but we never 1/2 the FSBG and dose off of that- we use the actual FSBG and 1/2 the SSI dose (and then round up if it comes out to X.5). I have seen this type of HS dosing at more than one hospital.

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Specializes in geriatrics.

I've never heard that or seen it written anywhere. Follow protocols and use evidence based practice. You need to have a sound rationale for these actions.

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I've never heard of anything like that during my short time as an LPN (3 1/2 yrs) nor was it ever mentioned during my schooling. Just texted a few coworkers and they all deny ever hearing anything like that while in school or in their years of practice.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What you are asking for is the "correction factor." I have seen this used only with insulin pumps. A correction factor is how much one unit of insulin will drop blood sugar. This number is different for everyone based on how sensitive they are to insulin. This can be calculated to estimate the correction factor by using the 1500 rule. Add up the total daily insulin dose for three days in a row and average the three days, then divide 1500 by the total daily dose. Example: If 30 units of insulin is taken each day (basal and bolus doses) then the correction factor would be 50. One unit will lower blood sugar 50 points. This rule is for regular insulin and there are different rules for Humalog and Novolog. You will add this correction to the meal time dose based on the pre meal blood sugar. You only add insulin to the basal rate when the blood sugar is above the target goal. However, if the blood sugar is very low, you can use the correction to also lower the meal time dose.

This might explain it better. Bu tlike I said I have only seen this used with insulin pumps.

Correction Factor | Diabetesnet.com

Another reference but I have not heard of the conversion you collegue speaks of.

http://www.dapc.info/PDF%20Literature/112%20Insulin%20Initiation.pdf

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Specializes in Med Surg - Renal.

Glucose swings depend on a heck of a lot more than just what the patient is or isn't eating or what the BG level is at one point in time.

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Specializes in Pediatric Hem/Onc.

Never heard of it....and I'm a pumper myself. None of the hospitals I've been in as a patient, student, or RN have those rules either. If it's a correction factor/sliding scale, it wouldn't matter if the trays were there since you're only correcting the current BS. It's reasonable to assume patients would want their correction and mealtime dose in the same injection so waiting for trays makes sense (especially if you're using a fast acting insulin.)

I've been diabetic for more than half my life and I've never heard of this 50% junk. It wouldn't surprise me, considering how diabetic care in a hospital is inadequate for establishing/maintaining control - just my humble opinion, of course :) Hope this helps!

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