what would you do in this situation?

That sort of is an odd way to giving insulin. Is this person not getting a basal or a longer acting insulin as well? My concern would be to give that much insulin that can last up to 6 hrs and then have a longer acting one in there that peaks somewhere in the middle. Does that make sense?

I would double check with the dr and I certainly woulnd't be giving that much insulin without making sure the pt ate really well and had a snack during upcoming hours.

basal, sorry, I was trying to think of the word. Thanks for comment. But, yeah, it was a basal amount plus sliding scale. Added together it was 20 units with a blood sugar of 200. I would imagine that would bottom the pt out. All of it was lispro. I would be terrified to give that much. That's why I asked. I was just wondering what you guys would do and if it's acceptable to give the basal amount, then re-check the bs, and if needed give the amount of sliding scale that was previously indicated?

okay, I guess you could check previous insulin administrations in the computer to see how the pt tolerated it. The patient was not eating at the time administered, that's why I said you better have that OJ, peanut butter, etc. on hand just in case.

Ask the person about their usual home routine with insulin (i.e. do they take a routine dose with a SS dose before meals). If so, give it. There might also be extra insulin if their blood sugars are running high if their body is stressed by disease process/hospitalization. Also, have they been in the hospital getting this dose or is this a new pt to your facility? If you still don't feel comfortable with it, call the doctor. While the doctor may not like it if you call about all his/her insulin orders, I think calling him/her is better than 'free style' glucose management (such as the give some insulin, check blood sugar, give more, etc...).

I would agree with previous posters ask the patient, review the patient history and then call the Doctor. Some patients don't have any idea what is going on but many do and all you have to do is ask. It is important to include your patients in their care. It is also great you asked the nurse. It is important to patient safety to be humble enough to ask questions. Best of luck

I was just wondering what you guys would do and if it's acceptable to give the basal amount, then re-check the bs, and if needed give the amount of sliding scale that was previously indicated?

What I see happening with this practice: You give the basal, recheck and they are "normal" so you don't give the SS insulin, a couple hours later they are 300. If you just gave the full amount in the first place you wouldn't be chasing the high. Like someone else mentioned, the doctor didn't just come up with the dosing out of the blue, this is probably something they do at home and that their body is used to. Definetely double check if you don't feel comfortable but seeing what they've gotten previously (and tolerated) can tell you a lot.

Try a CF induced diabetic's meal with carb counting. The 50 unit syringes won't be big enough.

The big secret to nursing is that it isn't about textbook patient on a textbook day with textbook values. For blood sugars, insulin doses, vital signs, don't look at one number by itself. Look at the pattern, the trends.

BP is normal, should you give the BP med? Most likely yes, as it's normal because of getting the BP med. Same with insulin. If a dose seems high, have they been getting about the same amount? What have the results of their previous doses been?

And in the back of your mind, know the "antidotes." Know where oxygen supplies are, where to get narcan from, where to get an amp of D50 or glucose tablets, etc...

You'll feel better giving doses that are uncomfortable for you if you feel confident about what to do if things do go wrong...

I agree that if you feel uncomfortable with the dosage of ANY medication, you need to check with the patient, check the computer and see if this is the patients norm, and you can always double the order with the doctor. Always follow the your gut.

I agree, you have to look at the individual pt. Has he/she been getting the same dose of lispro prior to meals and still running a blood sugar of 200. Remember the goal blood sugar while pts are in the hospital is 100 or less. Patients blood sugar will go higher when he/she eats so you are really covering a blood sugar higher than 200 you got by blood sugar readings. This is where knowing when each insulin act and how long it acts and how much each dose is likely to reduce blood sugars comes into play. Also look at what kind of doctor ordered the dose. Is it the patients endocrinologist who ordered it or someone who doesn't know the patient well? Is the patient on solumedrol or another steroid that will send diabetic patients blood sugars out of whack and even some patients who are not diabetic will run high blood sugars. Treat the patient not the book.