Nursing Students Student Assist

Published Feb 6, 2015

maria48

10 Posts

Calling all nurses..

I'm new to nursing and I know this may seem a stupid question but I just wanted to know.. I will be starting my clinicals soon so....

What I understand about Insulin is they are ordered by units. For pens, easy just dial to the desired order, however for the other insulins I've read to just also draw up the desired unit, for example (just making this number up) 30 units of long acting, then you just draw 30 units using an insulin syringe and give to patient. In the other problem I've encountered they're using D/H formula (Eg. 20 units of Regular Insulin. You are using U-100 insulin. how many ml do you give: answer 0.2ml) I was thinking of just drawing 20 units in a bottle. How do I know if I should just draw up the ordered unit or use the D/H formula. Pls explain... I don't want to give the wrong dose. I'm so anxious.

For Heparin, for example, doctor ordered 5,000 units SC. I have 3 choices (5,000/0.2ml) (5,000/1ml) (5,000/2ml) which do I choose? Does it matter?

Pls help I'm so nervous.

joy686

41 Posts

I am an RN,CDE. I specialize in DM. I am not sure what you are referring to when you say D/L. Insulin is always ordered in units. You will always use U100 insulin and a U100 .3, .5 or 1.0 ml syringe-unless you have pens. You probably won't see U500 insulin. Please clarify and I can try to help you.

Joyce

Thank you for the quick reply Joy. I've just encountered this that they had to use a formula, it's desired amount over available dosage as seen here.

Essential Mathematics for Nursing

If the doctor orders 20 units of insulin, do I just draw 20 units of the insulin in the vial and give it to the patient? or will there be a situation where I have to use a formula desired dose over available dosage for example, ordered dose: 20 units over (on hand U-100 units vial) that will give me 0.2 ml.

dream'n, BSN, RN

1,162 Posts

Never had to do a math equation for insulin. I think they are maybe talking about different dosing syringes? Like if you're using a syringe that's in mL versus units. If so, 100 units = 1 mL, therefore 10 units = 0.1 mL, etc.

As for the Heparin question: how I have always seen it SC is 5,000 units per 1 mL. Can't give more than 1 mL in a SC injection, so no 5,000 units in 2 mL or you would have to give the patient 2 injections and the lower dose is so small it would be much easier to overdose the patient.

BTW, alot of medication math problems can be solved in your head because they are pretty simple, but they are teaching you the D/H equation for the problems that aren't simple to solve. Same thing, but I use W/H (want/have) instead of D/H since I think "white house" to remember the equation.

Thank you dream'n. Yeah, guess that was for different dosing syringes. And as for heparin, thanks for clarifying now I'm getting it. I think I just have to be observant in the ward on how they give medications. Big thanks from me..

tyvin, BSN, RN

1,620 Posts

You need to get help from someone in your area that can sit you down and show you. The link you provided is simply conversions for vials. The vials are very basic. They tell you how much of whatever to put in to get x amount of medication.

BTW; you must always check your insulin draws with another RN; this is gospel. Created specifically for concerns just like yours. Yes, if the order is for x amount, draw up x amount from the insulin vial (make sure you got the right insulin).

The typical "formula" you will run into with insulin orders is a sliding scale. Sometimes it's written under the routine order and sometimes not. I've also seen sliding scale orders with no routine insulin order. There will be times when an insulin order will call for combined insulins (2 different types of insulin). The order will specify which to draw first (it should anyway), but it's usually common sense once you get to know your insulins. Know your syringes...I

I'm glad you're asking the right question but IMO this is something that must be taught and demonstrated to you in person.

Know the difference!

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0CEQQFjAD&url=https%3A%2F%2Fwww.bd.com%2Fus%2Fdiabetes%2Fmain.aspx%3Fcat%3D7002%26id%3D7427&ei=9K3UVLHpLpHooASf2oHoDA&usg=AFQjCNFgQZm_W1WsrX3m2bYjHRBVtH9Wcw&sig2=N17wLxcA_Op8imTUC-bKXQ&bvm=bv.85464276,d.cGU

VANurse2010

1,526 Posts

You need to get help from someone in your area that can sit you down and show you. The link you provided is simply conversions for vials. The vials are very basic. They tell you how much of whatever to put in to get x amount of medication. BTW; you must always check your insulin draws with another RN; this is gospel. Created specifically for concerns just like yours. Yes, if the order is for x amount, draw up x amount from the insulin vial (make sure you got the right insulin).

No, it isn't gospel. We are allowed to give insulin both in drips and subc. without a cosigner where I work. There are meds that require a co-signers, but insulin isn't one of them.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

I have double checked my insulin with another nurse for 35 years. Not all facilities required it...but I did it for my own sanity.

calivianya, BSN, RN

2,418 Posts

You shouldn't ever worry about mls for insulin. Always, always, always use an insulin syringe, which is marked in units. You will be far less likely to make a mistake. Converting units to mls is adding a step that does not need to be added and could result in an error.

psu_213, BSN, RN

3,878 Posts

It is not gospel to always check an insulin dose with another RN; however, I recommend it.

Anyway, insulin should always be given using an insulin syringe. I recently read a blurb in a nursing journal about nurses using tuberculin syringes to give insulin and the med errors associated with it. The markings on the syringe are in units. Draw up the number of units of insulin, check it with another RN, and give it. No math required.

As for the heparin, make sure the vial you are using contains heparin suitable for SC use. I have only seen the 5,000 units/mL. If each one is OK for SC use, it should not matter which one you use--just be sure to double check that it is 5,000 units.

I think that's AOK, but you're not posting that it's the norm everywhere.