When do you give long & short lasting insulin?

classicdame, MSN, EdD · Jun 7, 2010

Since the medication administration is a medically delegated act it is not up to the nurse to determine when a med is given, so I do not understand the question. Long-acting (basal) insulins work over 18-24 hours and are meant to keep the overall BS under control. They are not meant to treat an acute high BS. Short acting are the opposite. They are meant to treat an acute high BS, such as what you would expect following a meal consumption.

My basal insulin is generally prescribed once daily, but I split the dose and inject twice daily for better coverage (with MD approval). There is so much to know about insulin, and so many types, that I can only recommend you google for a chart on the peaks and actions of all of them.

healthstar, BSN, RN · Jun 9, 2010

Since the medication administration is a medically delegated act it is not up to the nurse to determine when a med is given, so I do not understand the question. Long-acting (basal) insulins work over 18-24 hours and are meant to keep the overall BS under control. They are not meant to treat an acute high BS. Short acting are the opposite. They are meant to treat an acute high BS, such as what you would expect following a meal consumption.
My basal insulin is generally prescribed once daily, but I split the dose and inject twice daily for better coverage (with MD approval). There is so much to know about insulin, and so many types, that I can only recommend you google for a chart on the peaks and actions of all of them.

I know that it is not up to the nurse to determine when the medication is given.

Thank you for the answering my question, this is what I was looking for.

JPORCH · Jun 16, 2010

The answer is going to vary depending on the patient because the dosages and times are going to be different depending on the individual patients needs. For ex. Lantus is a long acting basal insulin which is usually given in one dose at bedtime and lasts up to 24 hours. But sometime you will see the dose given in the morning or sometimes even split and given in the morning and before bedtime. Again it just depends. As for Humalog/Novolog short acting insulin it is given as a bolus at meal times (covering carbohydrate intake) and as a correction when the blood glucose levels are high. Hope this helps.

silverhalide · Oct 2, 2012

I have a question regarding this as well. Is Humalog also used as a corrective insulin (based on BS) at bedtime along with Lantus?

classicdame, MSN, EdD · Oct 2, 2012

Rapid acting insulin should not be given at bedtime for fear of hypoglycemia. Our facility policy is to check BS at bedtime, but call the MD for an order if over 150. Lantus does not peak so hypoglycemia is not associated with that med.

silverhalide · Oct 2, 2012

that's what I thought, but I hear it also being used as a general corrective insulin outside of mealtimes. A bit confusing. It would also be held if the individual does not want to eat correct? (Humalog)

MySonIsAdorable · Oct 3, 2012

With every doctor and every patient the orders are different. Sometimes you will use your nursing judgement, say a person who has a sliding scale and routine insulin and the pt has 68mg/dL the sliding scale certainly wouldn't prompt for the insulin administration so I would hold the the routine regular/fast acting insulin. Give some milk & graham crackers or something like that. In my facility we are to call the lab & notify the PCP if the bs is 400. We have an amount of insulin to give at 400 usually per sliding scale but we also have rapid acting insulin for community use that we can use if the PCP so orders when we call. However we have no standing order for a certain amount.

This is one of the most dangerous drugs we give and a lot of nurse I have met do not take it seriously enough. A nurse told a coworker the other day that she would not bother to give 2 units of regular insulin if so ordered by sliding scale. This is nuts! Most nurses I work with would rather the persons BS be high than low because being his is corrected, however being high is very dangerous also.

My best advice is to learn all that you can about DM, insulin, and hypoglycemia because its very common and something you will be dealing with often. best of luck

CDEWannaBe · Oct 4, 2012

You already understand that there are short acting and long acting insulins. The most common are:

Short acting - Humalog, Novolog, Regular

Long acting - Lantus, Levemir, NPH

The short acting starts working quickly and is used primarily to cover carbs eaten at a meal and corrections for high blood sugar. Because of insulin pumps diabetics now more frequently refer to these doses as "bolus" insulin.

The long acting provides background insulin. Even if nothing is eaten, the body needs insulin to transport glucose (made by liver or converted from stored glycogen) into the cells for energy. Long acting is typically given once or twice a day. Because of pumps, diabetics often refer to this as "basal" insulin. Easy to remember because basal is the base insulin.

The reason a lot of diabetics on insulin have highs and lows is because basal insulins like Lantus, Levemir and NPH just provides one level that isn't tailored to the individual. In reality, our bodies need different basal rates at different times of day. I'm a pump use and pumps use only short acting insulin for both the bolus and basal coverage because they give insulin 24/7. My basal rate varies from .5u an hour at some times of day, all the way up to 1.6u an hour in the early morning when I have insulin resistance from dawn phenomenon. Thanks to a pump, I can set my basal insulin to exactly what I need.

Hope that helps. If you really want to find out about doing insulin there is a great book by John Walsh called Using Insulin. My local library has a copy, so you might find the book at your library.