Time b/w BG check and insulin administration?

[Michelle King]

Hi,

I've been on my orientation at a rehab facility. I was wondering what the time frame b/w checking BG and administering insulin should be? When I was with my preceptor, she checked BG about an hour and half before giving insulin. Is this ok to do because I always thought it had to be a little shorter, like 30 mins?

Also, when I am giving rapid-acting insulin to patients. The patients are usually given their dinner trays around 5:30. My concern is whether it is safe to give this type of insulin without their meals in front of them yet? I know they're supposed to be given it 15 mins before eating, but I'm concerned if their dinner tray comes too late or they don't feel like eating... Is it ok to just wait until the food is actually there or when they finished eating?

[Dogen]

CBGs change over time (obviously, right?), so insulin should be given as close to the CBG as possible. For instance, a rate of change of 1-3mg/ml per minute isn't uncommon, and if your patient's CBG was changing on the rapid side it could go from 80 to 350 in 90 minutes. Of course this is unlikely for a variety of reasons (rate of change that high is more likely after eating or receiving insulin rather than before, for instance), but it's only meant to illustrate that blood sugar is changing all the time, so the only way to give the right dose is to do it soon after testing. My hospital doesn't have a policy on this, but my own policy is within 15 minutes.

I don't give my patients insulin until their tray is in front of them. It's not uncommon for trays to arrive at inconsistent times, or to have the wrong things on them (vegetarian gets a hamburger, lactose intolerant pt gets mac and cheese, etc) that end up delaying when they actually get to eat. It's not ideal, but it's safer than giving them insulin only to find they can't eat/hate the food and have to do hypoglycemia protocol on them later. If our SS insulin orders allowed split dosing I'd do that (give correction dose ASAP and come back with meal dose when the tray gets there), but they don't. Because hospital insulin orders are often stupid.