Question regarding insulin administration

CDEWannaBe · Jan 26, 2012

I've had type 1 for over 30 years and have never heard the 50% rule.

However, in theory it should work. Your co-workers rule is just that if blood sugar is at least 160 (because 80 or above is safe) then insulin can get a headstart before food arrives. The only catch is that the patient would need to eat 15-30 minutes within getting the insulin or it could cause a low.

Another drawback is if the patient has delayed digestion because the meal is high carb or high fat then it could cause a low.

Like others have said, stick to giving insulin as ordered.

Meriwhen, ASN, BSN, MSN, RN · Jan 26, 2012

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've heard of it being done.

IMO, I wouldn't do it myself--I'd give the insulin as ordered or if necessary, contact the doc, explain what's going on with the patient and see if the doc wants to tweak the insulin dose.

mappers · Jan 26, 2012

Thanks for the responses. This nurse has been a nurse a lot longer than me and worked in several areas. But this threw me when he mentioned it. Then I couldn't find anything on it when I researched it. I did find what Esme talked about, but that doesn't sound like what he was talking about. Meriwhen, interesting that you've heard of it, one other responders haven't. What area are you in? Maybe that's a factor?

Meriwhen, ASN, BSN, MSN, RN · Jan 26, 2012

Meriwhen, interesting that you've heard of it, one other responders haven't. What area are you in? Maybe that's a factor?

Don't know if that affects it: I'm in psych and I've never personally seen it done at any of my facilities...though that's not to say there isn't some nurse or two in there doing it. But I've heard about it from med-surg nurses.

classicdame, MSN, EdD · Jan 27, 2012

there ARE different formulas for determing insulin doses, but most are based on weight and carbs. I have not heard of this proposed method and, since prescribing is not within my scope of practice, I would not administer. If I felt like the dose exceeded the need, I would consult MD

psu_213, BSN, RN · Jan 28, 2012

No never heard of it...

Plus, why is it so difficulty to make sure the food tray gets there and the pt is going to eat before giving the SS dose?

Wishinonastar, BSN · Feb 1, 2012

This is what you would call a "rule of thumb", something gleaned from experience and work habits. This is not a standard of care. There are lots of these kinds of things in nursing passed down from nurses over the years. We used to look at the ears to determine if they were dying, for example. After you have been around a while you hear a lot of these, some that have no proof in science. Intuitively it makes sense, and probably some doctor or someone somewhere answered a nurse's question about whether to hold the insulin or not by telling them this.

I think this nurse was trying to reassure you. In some areas like LTC there are so many on meds that it is nearly impossible to give the insulins all at the correct time. So something like this is relied on as a rule of thumb- if the blood sugar is too low you need to wait on Mrs. B's insulin, but Mr. C is at 200 so it is ok to give it a little early. Save Mrs. B for last since she is only at 120. Plus the med nurse often has to help with feeds, so she really has to triage the patient meds.

I would never take this as science, but I don't think it is particularly odd either. These days we have more standards and guidelines to go by. In the past we often went by such rules of thumb.

mazy · Feb 1, 2012

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.

This is really interesting because we just had a patient come back from the hospital with these orders and we were all scratching our heads because we had never seen anything like it. That is, 1/2 the dose, not 1/2 the FSBG.

But correcting the dose based on FSBG without a dr's. order is something I've never heard of.

HalfmoonMaggieRN · Feb 2, 2012

This reminds me of the old "sick-day rules". Insulin-dependent diabetics were taught to give 50% of their usual insulin dose on days when they were ill and would likely not be taking their usual diet. I'm not a diabetes educator, but my recent reading supports the idea that the body's sympathetic response to the stress of illness will increase the blood glucose level, and subsequently increase the amount of insulin needed. The usual insulin dose should be taken. In these days of glucometers and home testing for BGLs, I've most often seen patients in the community instructed to monitor their glucose levels more frequently on these days. They may be given an alternative scale, but in any case they would almost certainly be given BGLs for calling the practitioner. In a hospital, request new orders from the practitioner. An intermediate or long-term care facility may have standing orders, and your assessment will tell you when these orders are insufficient.

Karen · Feb 22, 2012

I haven't heard of that but in general for someone without a lot of insulin resistance (which type 2 diabetics would have) 1 unit of regular insulin will reduce blood glucose by 10. So in terms of having an idea of what will happen when you give it you can figure if you give 5 units of regular it will decrease by 50 (or less with insulin resistance) but as far as deciding to give something other than what is ordered that is out of your scope of practice.