Create a PowerPoint about Insulin (10-12 slides) Include reference page Key nursing implications related to the topic. The significance of understandi

Page 1 of 2 SO-0006-SMH Rev. 4/30/19

07600SSO06

*07600SSO06*

PHARMACY STAT (Place X in Box)

Print Physician’s Name: _________________________ Physician’s Signature:_________________________ Date:________ Time:______

SCANNED DATE: _______ TIME: _______ INITIALS: _______

SOUTH MIAMI HOSPITAL EBCC SUBCUTANEOUS INSULIN (Diabetes / Hyperglycemia Management) ORDERS

1. Prescriber to discontinue previous insulin and/or oral diabetes medication.

2. T Hemoglobin A1C (Do not perform if a level is available in patient’s chart within 90 days from admission)

3. Test Blood Glucose (BG) level: £ 15 to 30 minutes before meals and bedtime £ 15 to 30 minutes before meals, bedtime and 3 AM £ Every 4 hours for NPO patients £ Every 6 hours for NPO patients £ Continuous parenteral/enteral feeds, every 6 hours and change to before meals, bedtime and 3 AM once patient eating 4. BASAL INSULIN: Do not hold when NPO. £ Insulin Glargine (Lantus) ___________ units subcutaneously £ daily £ twice daily or £ Insulin NPH twice daily: ______________ units subcutaneously 30 minutes before breakfast and ______________ units subcutaneously at bedtime 5. MIXED INSULIN: Hold dose if NPO or if skipping a meal. Notify physician for dose adjustment if BG lower than 70 mg/dL Insulin 70/30 twice daily: ___________ units subcutaneously 30 minutes before breakfast and ____________ units subcutaneously 30 minutes before dinner 6. PREMEAL INSULIN: Hold dose if NPO or if skipping a meal. Notify physician for dose adjustment if BG lower than 70 mg/dL £ Insulin Lispro (HumaLOG) _____ units subcutaneously within 15 minutes of breakfast ______ units subcutaneously within 15 minutes of lunch ______ units subcutaneously within 15 minutes of dinner or £ Insulin Regular ____units subcutaneously 30 min before breakfast ____units subcutaneously 30 min before lunch ____units subcutaneously 30 min before dinner 7. ENTERAL FEEDS: If tube feedings or parenteral nutrition is interrupted, start D10W IV @ 50 mL/hr. Notify physician for further orders. • Continuous enteral feeds: £ Insulin Glargine (Lantus) _____ units subcutaneously £ Daily £ twice daily or £ Insulin Regular _____ units subcutaneously every 6 hours • Bolus feeds: 1. Choose basal insulin: £ Insulin Glargine (Lantus) ____ units subcutaneously at bedtime or £ Insulin NPH _____ units subcutaneously twice daily AND 2. Choose premeal insulin: £ Insulin Lispro (HumaLOG) _____ units subcutaneously within 15 minutes of bolus feeds or £ Insulin Regular _____ units subcutaneously 30 minutes prior to bolus feeds • Nocturnal feeds: Insulin NPH ____ units subcutaneously 30 minutes before initiation of feeding AND ____ units subcutaneously every morning. Add premeal insulin Insulin lispro (HumaLOG) _____ units subcutaneously within 15 minutes of meal 8. CORRECTION SCALE: Do not hold when NPO. Give correction with scheduled point of care blood glucose. Give in addition to routine basal and premeal insulin. £ Insulin Lispro (HumaLOG) £ Insulin Regular

Blood Glucose

level

£ Regimen 1 – Mild (for patients getting 0 – 30 units daily)

£ Regimen 2 (for patients getting 31 – 60 units daily)

£ Regimen 3 – Moderate (for patients getting 61 – 90 units daily)

£ Regimen 4 (for patients getting 91 – 120 units daily)

£ Regimen 5 – Severe (for patients getting

more than 120 units daily) £ Other

Less than 70 Call physician Call physician Call physician Call physician Call physician Call physician 70 – 120 No Coverage No Coverage No Coverage No Coverage No Coverage No Coverage 121 – 160 1 unit 2 units 3 units 4 units 5 units _____ units 161 – 200 2 units 4 units 6 units 8 units 10 units _____ units 201 – 240 3 units 6 units 9 units 12 units 15 units _____ units 241 – 280 4 units 8 units 12 units 16 units 20 units _____ units 281 – 320 5 units 10 units 15 units 20 units 25 units _____ units 321 – 360 6 units 12 units 18 units 24 units 30 units _____ units 361 – 400 7 units 14 units 21 units 28 units 35 units _____ units

Greater than or equal to 401

8 units & call physician

16 units & call physician

24 units & call physician

32 units & call physician

40 units & call physician

_____ units & call physician

Page 2 of 2 SO-0006-SMH Rev. 4/30/19

07600SSO06

*07600SSO06*

PHARMACY STAT (Place X in Box)

Print Physician’s Name: _________________________ Physician’s Signature:_________________________ Date:________ Time:______

SCANNED DATE: _______ TIME: _______ INITIALS: _______

SOUTH MIAMI HOSPITAL EBCC SUBCUTANEOUS INSULIN (Diabetes / Hyperglycemia Management) ORDERS

9. Hypoglycemia treatment for BG lower than 70 mg/dL. • If patient is conscious and able to swallow, give 15 grams of oral glucose (4 ounces juice or 15 grams glucose gel). Recheck BG every 15 minutes and repeat treatment until BG is greater than or equal to 90 mg/dL. Once BG is at or above 90 mg/dL, if the next meal is more than 1 hour away, give an extra carbohydrate and protein (1 pack graham crackers with 1 tablespoon of peanut butter). • If patient is unconscious, NPO, or unable to swallow and IV access is available, administer 12.5 grams (25 mL) D50W IV push for BG 50 – 70 mg/dL or 25 grams (50 mL) D50W IV push for BG less than 50 mg/dL. Recheck BG every 15 minutes and repeat treatment until BG is greater than or equal to 90 mg/dL. • If patient is unconscious, NPO, or unable to swallow and IV access is not available, administer Glucagon 1 mg IM. Recheck BG 15 minutes later and reassess patient. Administer Glucagon once only. If BG is still less than 90 mg/dL and patient is awake and able to swallow, give juice as directed. If patient is unable to swallow, obtain IV access and administer D50W as directed. Always notify physician. BG may be checked PRN if patient is symptomatic. 10. Notify physician for medication adjustments for blood glucose levels higher than 180 mg/dL for 2 consecutive readings or for any blood glucose lower than 70 mg/dL or higher than 400 mg/dL. 11. Complete critical value report for any value less than 60 mg/dL or higher than 400 mg/dL. 12. If results are unexpected or outside the limits of the meter, obtain STAT Lab glucose.

13. CONSULTS: £ Diabetes educator £ Case management for discharge planning £ Home health £ Referral to BHSF follow up care

DEFINITIONS

Basal Insulin – a steady, low dose insulin that works throughout a 24 hour period (Lantus) or a 12 hour period (NPH). This does not cover meals.

Premeal Bolus Insulin – given for meals to normalize post prandial blood sugars. Humalog is preferred over Regular as the action is faster.

Correction Scale – given in addition to a basal and bolus dose in response to a higher blood sugar value. The type of insulin used for premeal bolus insulin should be the same as the type of insulin used for the correction scale.

Target Blood Sugar – Target Blood Glucose (BG) is less than 180 mg/dL

GUIDE FOR INSULIN DOSE SELECTION BASED ON PATIENT’S WEIGHT

Patient’s Weight 0.4 units/kg Insulin sensitive, new onset DM

0.7 units/kg Moderate insulin resistant

1 unit/kg Severe insulin-resistant

(i.e., steroids, sepsis, pressors, obese)

Lbs Kg BASAL

daily dose (Lantus, NPH)

PREMEAL Lispro

(HumaLOG)

BASAL daily dose

(Lantus, NPH)

PREMEAL Lispro

(HumaLOG)

BASAL daily dose

(Lantus, NPH)

PREMEAL Lispro

(HumaLOG)

99-109 45-49 10 units 3 units 16 units 5 units 22 units 8 units 110-120 50-54 11 units 3 units 18 units 6 units 25 units 8 units 121-131 55-59 12 units 4 units 20 units 6 units 27 units 9 units 132-142 60-64 13 units 4 units 21 units 7 units 30 units 10 units 143-153 65-69 14 units 4 units 23 units 7 units 32 units 11 units 154-164 70-74 15 units 5 units 25 units 8 units 35 units 12 units 165-175 75-79 16 units 5 units 26 units 9 units 37 units 13 units 176-186 80-84 17 units 5 units 28 units 9 units 40 units 13 units 187-197 85-89 18 units 6 units 30 units 10 units 42 units 14 units 198-208 90-94 19 units 6 units 32 units 10 units 45 units 15 units 209-219 95-99 20 units 6 units 33 units 11 units 47 units 16 units 220-241 100-109 22 units 7 units 35 units 11 units 50 units 17 units 242-263 110-119 24 units 8 units 38 units 13 units 55 units 18 units 264-285 120-129 26 units 9 units 42 units 14 units 60 units 20 units 286-307 130-139 28 units 9 units 46 units 15 units 65 units 22 units 308-329 140-149 30 units 10 units 49 units 16 units 70 units 23 units 330-351 150-159 31 units 10 units 53 units 17 units 75 units 25 units

Greater than or equal to

352

Greater than 160 32 units 11 units 56 units 19 units 80 units 27 units